Appointment Request Form

 "We find what we expect to find, and we receive what we ask for" -- Elbert Hubbard

 

Please provide the following information AND read everything on this page:

You must be a registered student to make an appointment.  If you are not registered, click here to register.

Only 2 appointments per week.

This is just a REQUEST FORM. 

All appointments will be confirmed by Telephone.

Please fill in forms using the requested format.

Form submitted without using the required format can be discarded!
 
Last Name

First Name

Student ID

Phone Number

e-mail address

 

  


NOTE:  There's a greater chance of receiving an appointment if you request it 3-5 days in advance.
 
 

First Appointment

  

2Second Appointment
Date


MM/DD/YY

 Date


MM/DD/YY
Preferred Time 1

Preferred Time 1

Preferred Time 2

Preferred Time 2

From all the dates above that you are requesting appointments, how many appointments do you want made?  Note:  Only two appointments per week.

1
2
3
4

Important Note:  If you are an EOPS STUDENT, then you may have a standing appointment for the rest of the semester.  Your appointments will automatically be made for every week; all you have to do is show up. 

 

Are you an EOPS STUDENT?

Yes

No

 

Is this Appointment Request for a standing appointment?

**This only applies to current EOPS STUDENTS, and you will be asked to verify your status as an EOPS STUDENT.**

Yes

No

Please note: Appointment Policy (below) still applies to all EOPS STUDENTS. If you need to make any changes in your standing appointments schedule, please check box below, and changes will be made within the system.

Update for all future Standing Appointments? 

 
Would you like to be reminded in advance of your upcoming Appointments? Yes
No
 

To Complete Request, please read the Appointment Policy below. 
Check the box labeled 'I Agree' which signifies that you completely understand and adhere to this policy.

  I Agree 
CLICK SUBMIT BUTTON BELOW

Please indicate in the box below your goals or expectations from being  Tutored in the Math Lab. 
 What do your expect the experience will be like? 
This comment is very important!

 

Appointment Policy :

 **There is a maximum of two (2) scheduled appointments per week. 

 **Appointments can be scheduled two (2) days in advance
(i.e. Monday appointments can be scheduled on Thursday)

 **Appointments must be cancelled 24 hrs in advance. 
Appointments not cancelled 24 hrs in advance will be considered a NO SHOW.

**After the second (2nd) NO SHOW, you will no longer be allowed to make any more appointments the rest of the semester. 
(Stand-by Appointments, Drop-In Tutoring & Workshops will still be available to you).

 **Call 310-434-4735 to CANCEL appointments

 **EOPS:  Please inquire about Priority Tutoring. 

 **If you are unable to schedule an appointment, please inquire about other resources available to you
(Stand-by Appointments, Drop-In Tutoring, and  Workshops)

 
 

                                                                                    

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