Reader/Tutor Request Form

Who is submitting this request (your name)?

Instructor/supervisor of Reader or Tutor (name)

Hiring Department

Course for which Reader/Tutor will be assigned

Account to be charged (if known)

Name of Fiscal Officer for account or Department Manager

Duration of Appointment
Duration of Appointment: Month Duration of Appointment: Day Duration of Appointment: Year Duration of Appointment
Duration of Appointment: Month Duration of Appointment: Day Duration of Appointment: Year Duration of Appointment

Duration of Appointment

Appointment percentage or average number of hours per week

Graduate Student Full Name

Graduate Student UCI Email Address

Graduate Student UCI Student ID Number

Graduate Student UCI Employee ID Number

Notes

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