Student Number

Home phone

Mobile

Email

Preferred form of contact
Email
Mail
Text Message
Phone Call

I would like to request a tutor for... (Please list course/s by course codes).

Please identify any other areas impacting your study where you would like further support:

By submitting this form, I understand and agree that:

1. The information submitted in this form will be treated confidentially by the Advisor dealing with this request and be used only to assist identification of further support options.
2. There is no guarantee of a match with a tutor for all requested courses, only that every effort will be made to recruit tutors to fill requests within a 2-4 week timeframe, with priority given to first year students.
3. The information provided in this form will be used by the Pacific Development Team for University purposes only.