Student Referral
Form
Faculty Request for Services
Course ______________________________________________
Instructor __________________________________________
Student _____________________________________________
Title of Assignment _________________________________
Nature of Service needed (please check all that apply):
___ Completing a paper
___ Revising a paper/improving a grade
___ Skill-building
Problems observed (please check all that apply):
___ Focus/precise
thesis
___ Sticking to one main point
___ Organization
___ Paragraph coherence
___ Development/adequacy of evidence
___ Logic
___ Adequate/ethical use of sources
___ Sentence clarity
___ General proofreading
___ ESL problems
Special Instructions/notes to help the tutor help your student:
I would like a written report on my student’s progress _______ (yes/no)
If yes, please indicate your campus mail code or email address _____________________
Email this form to the Writing Center
