First Name       

Last Name       

Social Security 


City                       State            Zip   

Telephone #     

Referred By           Date    

Are you taking any courses on the Teaneck Hackensack Campus?   Yes   No

What is your Major  

Year        Grad      Freshman      Sophomore      Junior      Senior

Areas in which you want help in:


I understand that the purpose of this contract is to establish conditions which help me to succeed in my program of studies.
As a participant in this service, I agree to:

1. Attend sessions regularly. I understand that I am allowed a Maximum of Two absences per semester per subject.
    More than two absences per semester per subject will result in cancellation of my tutorial privileges.

2. Meet all requirements of my courses. I will schedule time in advance of a due date to work on any assignment which will
    require advance preparation i.e papers.

By submitting this form I fully understand and intend to fulfill the requirements.