Roanoke-Chowan Community College

Assessment Form for Tutoring Service Request or Referral

THE STUDENT INDICATED BELOW HAS REQUESTED/IS BEING REFERRED FOR TUTORIAL ASSISTANCE THROUGH THE STUDENT SUPPORT SERVICES PROGRAM. TO ASSIST US IN SCHEDULING THIS SERVICE, AN ASSESSMENT OF THE STUDENT'S CURRENT LEVEL OF PERFORMANCE IN THIS CLASS IS NEEDED.

Please indicate the student's current level of performance in the class:(check all that apply)

The student could benefit from the following types of assistance:(check all that apply)

What is the student's current level of performance in this class?

If you have any questions or need clarification, please call Isalean Overton at ext. 241. Thank you so much for your cooperation and assistance.