Tutor Request Form - Department Of Chemistry 5.12 Organic Chemistry I

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Department of Chemistry
5.12 Organic Chemistry I
Tutor Request Form
Tutors are available to assist students in their Chemistry classes. To receive tutoring services:
Complete this referral form and give it to your TA for approval
•
Your TA will complete the TA Diagnostic (this can be done with you) and will submit your
•
application
A tutor will be assigned to you and will contact you.
•
Please note: to be eligible for tutoring services, a student must be attending lectures and recitations
regularly, turning in problem sets and attending office hours.
Name:
Date:
Email:
Cell Phone No.:
T.A.:
Exam Scores:
Ex I _____
Ex II _____
Ex III _____
Ex IV _____
SELF D IAGNOSTIC
I need help with the following topics (check all that apply):
_____ acid/base and pKas
_____ stereochemistry
_____ conformational analysis
_____ free radical reactions
_____ S
1/S
2/E1/E2
_____ carbocation stabilities
N
N
_____ reaction mechanisms
_____ aromaticity and EAS
_____ molecular orbitals
_____ electrophiles/nucleophiles
_____ carbonyl chemistry
_____ retrosynthesis/synthesis
_____ other __________________________________________________________________
For each topic checked, assess where you are having trouble and what you need to work on:
TA DIAGNOSTIC
For each topic checked, assess your student’s command of the material and what the tutor should
emphasize.
______________________________________
(T.A. signature)
Office Use Only
Assigned to: ____________________________________________ By _________ Date ___________

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