Study Clinic Attendance Form

Study Clinic Facilitator Information:

* denotes required fields

*First Name


*Last Name


*Session Date

Student Information:

* denotes required fields

*Student's First Name


*Student's Last Name


*Student's SUID #


*Course (Dept/Course#)

Student requested assistance with: (check ALL that apply)

Basic Homework Help:
Completing Assignments
Get Questions Answered
Other(outline help, draft re-write )

Class material assistance:
Clarify Concepts
Test Help
Post Test Review
Other

Study Strategies:
Memorization
Other Techniques

Other:
Other Assistance (emotional support)

Please provide two to 3 sentences for each of the following topics.