Tutorial Request Form- With Reference Notes

Name ______Date______
Grade______/ Period ______
Tutor Signature ______
Question : (Directly from the book/quiz/homework, etc)______Level (must be 2 or 3)
- As I review my resources (CNs, textbook, workbook, quiz, test,etc) what is something that I don’t understand?
- How can I simplify and explain this question in my own words?
Subject ______Teacher______Teacher Initials ______Source______

Key academic vocabulary/definition associated with this topic and question:
- What are the key academic vocabulary words I need to understand?
- What is the definition from my book or class notes?
- Can I define them in my own words?
What I already know about my question:
- What do I know about my initial question?
- What concepts does this remind me of?
- How can I organize the information?
- How can I connect it with prior knowledge from this content area or anther subject?
- Can I make a prediction about a reasonable answer?
Rewrite question from your Point of Confusion:
This is your tutorial question. Use the academic vocabulary and create a question based on your point of confusion (POC).

Reflection:

My point of confusion was:
______

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What I learned about my POC was: ______

______

I gained a new/greater understanding of my POC by/when: ______

______

______

This learning is important because it connects to my previous learning/experience, myself, and/or my world in the following way: ______

______

______

What I found meaningful in today’s tutorial session was______

______

______

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First two items must be filled in before you arrive in class in order to get credit:
Name, date, problem subject, subject teacher 0 1 2 3 4 5
Specific questions, level 2 or 3, and sources 0 1 2 3 4 5
Cornell notes on student presenter’s question 0 1 2 3 4 5
Stays on task, participates, asks questions 0 1 2 3 4 5
Ready to work, has completed prework 0 1 2 3 4 5
Completed Reflection 0 1 2 3 4 5

NOT PREPARED WITH COMPLETED TRF= ½ credit (student can only receive 15 of 30 possible points)
Teacher/Tutor Notes: ______

______