Peer Tutoring Request Form (Student) Peer Tutoring Request Application Student Information You must be enrolled at ELAC for the current semester and must present your student ID or registration receipt to gain tutoring access. Enter Student ID number: * Enter ELAC Password: * Re-Enter your Student ID number: * In order to log in to use ELAC services, you need to know your student ID number and your ELAC password. Your student ID number is a nine digit number beginning with "88". Your password is Elac + Month + Day of birth. For example, if you were born on January 31st, your password would be: Elac0131. This application is for: Fall Spring Winter Summer Personal Information Full Name: * Full Street Address: City: State: Zip Code: Email Address: * Gender: Male Female What is your primary language? Birthdate: Primary Phone Number: * Alternative Phone Number: Educational Background Highest Level completed (or level recommended by placement exam): English: Math: Units You are Currently Enrolled: What is your major? Have you completed an education plan? Yes No Have you seen a counselor? Yes No What is your educational goal? Prepare for a new career (acquire new job skills) Advance in current job/career (update job skills) Discover/develop career interests. plans and goals Obtain a two-year vocational degree without transfer Obtain a two-year Associates degree without transfer Obtain a vocational certificate without transfer Obtain a Bachelor's degree after completing an Associate's degree (UC and Private Universities Only) Maintain a certificate or license (e.g. Nursing, Real Estate) Improve basic skills in English, Reading, or Math Complete credits for high school diploma or GED Undecided on Goal What other services are your receiving from ELAC? Financial Aid EOP&S University Center CalWorks Math Lab MESA Adelante/FYE Counseling Dept. DSP&S Reading & Writing Center Library None Other What subject do you need tutoring in? How may we best assist you as you receive tutoring? Have you used the Learning Center's services before? Yes No What is your Enrollment Status: First time college student Continuing Student First time at this college, after attending another college Returning to this college after attending another college Returning to this college without having attended another college When do you plan to transfer?