Kansas State University

Name:

Student ID#:

Phone:

K-State E-mail (only):

Are you currently a member of Student Support Services/TRIO? Yes No

If not, please answer the following questions:

Has either of your parents completed a Bachelor's degree? Yes No

Are you a Pell Grant recipient? Yes No

Do you have a disability? Yes No

Please list the course(s) you are requesting tutoring?

Course
Instructor

Course
Instructor

Course
Instructor