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Referring Teacher Information
First Name
Last Name
Grade Level
Email Address
Phone Number
Email is our primary means of communication; if you prefer that we communicate with you via phone, please check the box below.
I prefer to be contacted via phone.
School (please select one)
Anderson
Bozeman Summit School
Chief Joseph
Emily Dickinson
Gallatin Gateway
Great Beginnings
Hawthorne
Hyalite
Irving
LaMotte
Longfellow
Malmborg
Meadowlark
Monforton
Morning Star
Sacajawea
Whittier
Other:
In which subject(s) do your students need tutoring?
Reading
Math
Both
Grade level of students needing tutoring (Please check all that apply.)
K
1
2
3
4
5
6
7
8
Please indicate days/times when your class schedule would permit your tutor to work with students.
Please indicate days/times when your class schedule would permit your tutor to work with students.
Monday
Tuesday
Wednesday
Thursday
Friday
8:00-9:00 a.m.
Monday
Tuesday
Wednesday
Thursday
Friday
9:00 a.m. - 10:00 a.m.
Monday
Tuesday
Wednesday
Thursday
Friday
11:00 a.m. - 12:00 p.m.
Monday
Tuesday
Wednesday
Thursday
Friday
12:00-1:00 p.m.
Monday
Tuesday
Wednesday
Thursday
Friday
1:00 - 2:00 p.m.
Monday
Tuesday
Wednesday
Thursday
Friday
2:00-3:00 p.m.
Monday
Tuesday
Wednesday
Thursday
Friday
Referring Teacher Memorandum of Understanding
In order to better assist each student receiving tutoring, I agree to the following; I will:
1. Treat tutors with respect and dignity and establish ongoing communication with the tutors in my classroom.
2. Act as an in-class supervisor and resource to tutors.
3. Only utilize MSU AR® AC tutors with students in one-on-one or small-group tutoring situations.
4. Verify the tutor's presence in my classroom on a monthly basis by signing his/her monthly timesheet.
5. If possible, notify each tutor when his or her student is absent or provide another student for the tutor to mentor on that day ONLY.
6. Forward a copy of the "Refusal of Service" form to the parents/guardians of the child referred, and establish, by their lack of response, permission to refer the child to the AR® AC program.
7. Understand that all MSU AR® AC tutors are university students, and remain aware that scheduling challenges may result.
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