Supplemental Instruction - Simmons College of Kentucky

Level Up Supplemental Instruction

Date*

Student Name*

First Last

Student Email*

Simmons Email Simmons Email

Student Phone*

Text Messaging*

Are you able to receive text message notifications? (standard text messaging rates apply)

YES
NO

Year*

Major*

Have you used Student Support Services before?*

YES
NO

How did you hear about supplemental instruction?*

List the course title, professor, and meeting information for which you are requesting a Supplemental Instructor:*

Use the "+" to enter information for another course.

ENTER Course title in space below:	Enter Course professor in space below:	Enter Days/Times the course meets in space below:

What specifically do you feel you need assistance with?*

What days/times work best for you to receive supplemental instruction?*

Select ALL that apply.

Is there any other information you would like for us to know?*

YES
NO

Additional information.*

Digital Signature*

POLICIES AND PROCEDURES*

1. An email will be sent to your student email account that includes the contact information for your Supplemental Instructor. Please contact them as soon as possible.
2. If you do not receive a confirmation that this form has been received after you submit, please contact levelup@simmonscollegeky.edu.
3. If you do not hear back from our office within 2 business days of submitting your request, please contact levelup@simmonscollegeky.edu.
4. Please contact your Supplemental Instructor as soon as possible to schedule your session(s).
5. If you have trouble making contact with your Supplemental Instructor, please contact us immediately at levelup@simmonscollegeky.edu, so we can help you find another Supplemental Instructor.
6. Supplemental Instructor referrals are subject to availability. If there is no Supplemental Instructor available for a requested course, we make every effort to recruit a Supplemental Instructor.
7. Please respect your Supplemental Instructor’s time. If you are going to be late or should you need to cancel a scheduled session, please contact your Supplemental Instructor as soon as possible.
8. Supplemental Instructors are not permitted to assist students with graded homework assignments or take-home exams. Supplemental Instructors assist students with understanding underlying concepts and solving sample practice problems, as well as developing specific study strategies for the subject.

Questions or concerns about supplemental instruction? Email us at levelup@simmonscollegeky.edu.

I have read and agree to the policies and procedures as stated above.

Name

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Six Sunday School Lessons During the 40 Days of Prayer

Supplemental Instructor Request

Level Up Supplemental Instruction