William Paterson University

College of Science and Health

Department of Nursing

Nursing Enrichment and Tutoring (NET) - Faculty Referral Form

Faculty-Please complete gray section

Student Name: __________________________________________________________

Course: __________________ Date: __________________________________

Cell Phone ___________________________ Student ID # _________________

Referring Faculty: ___________________________________________________

Faculty Evaluation

Objective/Problem to be addressed:

‰ Exam: grade _____________ Next Exam date: __________________

Content to review ____________________________________________________

‰ Paper: grade _____________ Next Assignment due _______________

Comments: ___________________________________________________________

Other:

‰ Class Content ________________________________________________________

‰ Clinical Practice ________________________________________________________

‰ Writing Help

Optional: Recommendation NET sessions: ‰weekly ‰once ‰as needed

Student Self Evaluation (Student to fill out this section)

‰ I would like help with____________________________________________________

______________________________________________________________________________________

‰ Test taking Strategies My last exam grade _________________

Do you change your first answer?______________________________________

Do you read into the question? ________________________________________

Other thoughts _____________________________________________________

Time Available for Tutoring: ________________________________________________

NET Plan: (Tutor to fill out this section) _________________________________________

________________________________________________________________________

Please return to Wing 103

Ext. 3516