ORANGE COUNTY COMMUNITY COLLEGE
Learning Assistance Services/Academic Support
Middletown Coordinator-Eileen Burke – 341-4520
Newburgh Coordinator-Sarah Gardner-341-9032
Peer Tutor Application/Instructor Approval
FOR THE APPLICANT (Please Print)
Name
___________________________________
Date: ____________
SSN:
__X X X- X X-_________________________________
Address: ___________________________________
___________________________________
Phone:
________________ Cell: _______________
E-Mail:
____________________________________
Instructor:
Please Check One:
Student:

2-Year Degree
or Equivalent :


_________________________________
FOR THE INSTRUCTOR
I am familiar with the above applicant’s work and believe he/she has the skills necessary to be
an effective tutor for the following course(s):
Course # ___________
Course Title ____________________________
Course # ___________
Course Title ____________________________
Course #____________ Course Title ____________________________
________________________________
Instructor Signature
At the Newburgh Campus, please return this form to Sarah Gardner in the Learning Center on the second floor of Kaplan Hall.
In Middletown, please return it to Eileen Burke in the Tutorial Center on the second floor of the Library.
Notes:
Sent to H.R.__________
revised: 4/11
Assigned Password:
HR Approved__________
TT______