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Tri-C

Community Learning Center

Levin College of Public Affairs and Education

Academic and Degree Programs
Advising and Student Services
College Directory
Site Map

Community Learning Center

Our History
CLC Staff
Helpful Information
News
Services We Provide

CLC Center-based Tutoring and Registration

CSU Student Intake Form
CLC Faculty Intake Form

Outreach Sites and Forms

Outreach Site-based Tutoring and Registration
Student Intake Questionnaire

Staff Forms

Teacher Reporting Forms
Tutor Hourly Reporting Form
Tutor Reporting Form (General)
Tutor Reporting Forms

CLC Fundraising

Tri-C

Mailing Address
Cleveland State University
2121 Euclid Avenue, JH 130
Cleveland, OH 44115

Campus Location
2485 Euclid Avenue
Julka Hall, Room 130
Cleveland, OH 44115

Phone: 216.687.4768
communitylearningctr@csuohio.edu

Tutor Reporting Form (General)

Student Information (Please fill out the form for only one student at a time. Complete additional form for each additional child.)

1. Student Name:

2. Student Grade Level:

Pre-K

K

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

3. Reporting Tutor's Name:

4. Standards and Curricula Used:

5. Brief Summary of Learning Activities (include recommendations for future enrichment):

6. Rate the Students attendance and attention (scale 1-5; 1 being poor, 5 being excellent) and describe:

7. Student's Areas of Strength:

8. Student's Areas of Need:

9. Upload an tables or graphs of student progress data here:

One file only.
2 MB limit.
Allowed types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml zip.

Leave this field blank

Mailing Address
Cleveland State University
2121 Euclid Avenue, JH 130
Cleveland, OH 44115

Campus Location
2485 Euclid Avenue
Julka Hall, Room 130
Cleveland, OH 44115

Phone: 216.687.4768
communitylearningctr@csuohio.edu

2121 Euclid Avenue
Cleveland, Ohio 44115
(216) 687-2000

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