Why have you come to TRiO Student Support Services?
Why or why not?
Last Math Course?
Final Grade
When?
Where?

*Name

Phone #

*RIT E-Mail

*MajorCumGPAYear

Dean's List Probation CRP
Are you employed? Yes No
# Hrs/wk Where?

If yes, please explain
Are you receiving LSS Structured Monitoring? Yes No
Who is your LSS advisor?
Are you receiving accommodations Yes No
If yes, which ones?
Extended Test Time Notetakers Other

Course Repeat? Instructor
Yes No
Yes No
Yes No
Is your math course what you expected? Yes No
Please explain

Math Professor or Instructor
RIT Bates Study Center Math Tutoring
Sol Heumann Study Center
TRiO SSS Math Tutors
TRiO SSS Math Instructor
Sunday TRiO SSS Drop-In Tutoring
RIT Engineering Learning Center
Other

Grade High School Final Grade
9th
10th
11th
12th
Where?
Grad Date
Qtr Previous RIT Math Courses Final Grade






Math at Other Schools Final Grade




When?
Where?

I am successful at math when

Math can be difficult to do because

Name two of your favorite subjects in high school or college

1. I learn math best when it is explained
   Step-by-step 1 2 3 4 5 Conceptually
2. The math I like better is
   Algebra 1 2 3 4 5 Geometry
3. When I do math homework, I
   Try to understand 1 2 3 4 5 Rush to get done
4. I learn math mostly by
   Memorizing 1 2 3 4 5 Understanding
5. My math grades reflect my understanding
   Always 1 2 3 4 5 Never
6. Math has usually been
   Difficult 1 2 3 4 5 Easy
7. Algebra has a lot of
   Meaning 1 2 3 4 5 Rules
8. I learn math best with
   An Overview 1 2 3 4 5 Specific Examples
9. In math class, I am usually
   Attentive 1 2 3 4 5 Distracted
10. I prefer working
    With Others 1 2 3 4 5 On My Own