Academic Support
Dr. Mack Gipson, Jr. Building
Peer Tutor Reference Form

______________________________________ has applied to become a Peer Tutor in Academic Support at Paine College, starting in the ___________ semester. As part of the application process, he/she has listed you as a reference.  Please take a few minutes to evaluate this student by filling out this form.  Please return it to Ms. Frazier-Edwards, Academic Support, Dr. Mack Gipson, Jr. Building. Thank you for your input!!

Your name:	Your position:

How long have you known this student?

In what capacity have you known this student?

If applicable, which of your courses has this student taken?

Please check the appropriate boxes to indicate your assessment of the student:

Criteria	Excellent	Good	Fair	Poor	Unknown	

Knowledge of the subject

Interaction with others

Verbal communication skills

Written communication skills

Character

Reliability/dependability

Honesty

Self-control

Punctuality/attendance

Completion of assigned tasks

Adherence to policies and procedures

Appearance/grooming

Judgment/adaptability

Motivation

Enthusiasm

Do you know of any reason why I should not consider this student for employment as a peer tutor? If so, please explain.

Would you be willing to have this person tutor your students?   YES

NO (Please explain on back of page)

Do you recommend this student for employment as a tutor in the Tutorial and Enrichment Center?   YES    NO

Additional comments (may be continued on back of form if needed):

				Telephone	
Signature		Date		Number	

Office Location (Paine College) or Address (if not on campus):

rev. 10/19/12