Noncredit Classroom Assistance Request Form

Faculty Name:

Course:

Section # (required):

Room 1:

Room 2:

Email:

Campus:
CLC

Term:
One Two Three Four Summer

I would like assistance every week

Days that you would like assistance: Monday Tuesday Wednesday Thursday Friday Saturday

Start Time: End Time: Preferred number of consultants: Day/Time your class meets in the lab:

OR

I would like assistance on workshop days or these dates only

Date you'd like assistance (#1): Date you'd like assistance (#2): Date you'd like assistance (#3): Date you'd like assistance (#4):

Start Time: End Time: Preferred number of consultants:

Please include any additional comments or details about your request:

Please indicate when you would like this assistance to begin:
Week Two Week Three

Would you like the consultant to be present week 8 (if available)?
Yes No

Preferred writing consultant (if you have one or more):

Please briefly indicate what you will be asking your writing consultant to do in class.
This information is optional, but it helps us match the best writing consultant with your class’s needs.