Tutor Request

First Name *

Last Name *

Student number *

Phone *

Email *

Campus *

Cowichan

Nanaimo

tiwšɛmawtxʷ (Powell River)

Reason for this request *

Background in this subject *

Goals/Desired grade *

Special considerations

How are you willing to meet with tutors? *

Please specify (other) *

Permission *

The information on this form is collected under Vancouver Island University (VIU) privacy policies and privacy legislation. VIU collects and uses this informationfor the purpose of supporting the student through the Volunteer Tutor Program. As a publicly funded institution, VIU is required to provide descriptive statistical information about our student body to our Ministry. Your contact information will be shared withtutors for the purposes of matching you with students to tutor. By clicking the checkbox, you are consenting to have your information collected and shared in this manner.

Electronic signature *

By clicking the checkbox, you declare that the information provided in this request is true, complete, and accurate.

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