Subject Area Tutor Referral Form

Dear UHV Instructor:

_____________________________ has applied for a peer tutor position in the Academic Center.  We would appreciate your time in filling in the following brief questionnaire about this student’s academic and communication skills.  The subject he or she has applied to tutor is _________________.

Any comments you provide are confidential.  Please return this form through interoffice mail to the Academic Center. 

Your prompt attention is very appreciated and thank you for your time.

Sandra Heinold

Academic Center Manager

1. How would you rank this person’s oral skills on a scale of one to four (1= poor; 2=fair; 3=good; 4=excellent)?

1           2         3           4

2. How would you rate this person’s written communication skills on a scale of one to four (1= poor; 2=fair; 3=good; 4=excellent)?

1           2         3           4      

3. How would you rate this person’s interpersonal skills on a scale of one to four (1= poor; 2=fair; 3=good; 4=excellent)?

1           2         3           4         

4. How would you rank this  person’s knowledge of the subject area mentioned above?

1           2         3           4         

5. Please provide any additional comments in the space below or on the back of this sheet that would be useful to us in making a hiring decision:

________                                            _______________________________

Date                                                     Instructor’s Signature