Success Coaching Registration Form

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Name:
Email:
Success Coaching
CSU ID#:
Name:
Preferred Email:
Phone Number: Do you receive texts?
Yes

No

Have you received TASC services in the past? Yes

No

How did you hear about TASC?
Are you an undergraduate student? Yes

No

What is your major?
What is your class standing? Freshman

Sophomore

Junior

Senior

OPTONAL: Are you affiliated with any of the following? AHANA

CSU ATHLETICS

DISABILITY SERVICES
MCNAIR

TRIO

Please check the services you are requesting: Time Management

Anxiety / Stress

DISABILITY SERVICES

Test Taking

Note Taking

Reading Comprehension
Study Skills

Organization
Motivation

Memory
Not Sure

Other

Please list at least THREE days and times that you ARE available:

Date1: MondayTuesdayWednesdayThursday<!--Friday -->
Time1: 8:00am - 9:00am9:00am - 10:00am10:00am - 11:00am11:00am - 12:00pm12:00pm - 1:00pm1:00pm - 2:00pm2:00pm - 3:00pm3:00pm - 4:00pm4:00pm - 5:00pm5:00pm - 6:00pm
Date2: MondayTuesdayWednesdayThursday<!--Friday -->
Time2: 8:00am - 9:00am9:00am - 10:00am10:00am - 11:00am11:00am - 12:00pm12:00pm - 1:00pm1:00pm - 2:00pm2:00pm - 3:00pm3:00pm - 4:00pm4:00pm - 5:00pm5:00pm - 6:00pm
Date3: MondayTuesdayWednesdayThursday<!--Friday -->
Time3:
8:00am - 9:00am9:00am - 10:00am10:00am - 11:00am11:00am - 12:00pm12:00pm - 1:00pm1:00pm - 2:00pm2:00pm - 3:00pm3:00pm - 4:00pm4:00pm - 5:00pm5:00pm - 6:00pm
<!--Closed: Friday / 5:00pm-6:00pm -->

Time Available a.m.

p.m.

Phone: (216) 687-2012

Fall Semester Hours of Operation
Monday–Thursday: 9 A.M.–7 P.M.

Friday: 9 A.M.–4 P.M.

Campus Location
Berkman Hall (BH) 233
1899 East 22nd Street
Cleveland, Ohio 44115-2214
Phone: 216-687-2012
tutoring@csuohio.edu

Mailing Address
Academic Support Hub
Cleveland State University
2121 Euclid Ave., BH 233
Cleveland, Ohio 44115-2214