Learning Assistance Center

Student Success Center
Learning Assistance Center
Special Support Services
Supplemental Instruction Program

Request for Academic Skills Services

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Page updated: November 3, 2009

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Learning Assistance Center
The Student Success Center
The University of North Carolina at Greensboro
Location: 104 McIver Building
Street Address: 1008 Administration Drive, Greensboro, NC 27412
Mailing Address: PO Box 26170, Greensboro, NC 27402-6170
VOICE: 336.334.3878
FAX: 336.334.5341
EMAIL: lac@uncg.edu

Name: (first and last)
Please indicate your class level:
Major:
Student ID#:
Have you already completed a Bachelor's Degree?	Yes No
Local School Address:
Campus Box / Address:
Email: (userid@uncg.edu)
Phone Number:
Preferred Method of Contact:
Which of the following academic area(s) are you requesting assistance in? (Select all that apply)
Concentration:
GRE/GMAT/Praxis Testing Skills:
Learning Styles:
Listening:
Memory:
Note Taking:
Test Taking:
Time Management:
Reading Comprehension:
Stress:
Other:
Please briefly explain the difficulty you are experiencing with the above academic area(s).
Which semester are you requesting services for?
Please check all university populations that you are associated with. This information will be kept confidential. (Select all that apply)
SAS/100:
Office of Adult Students:
Academic Enhancement Programs:
Please indicate which of the following family members have completed a bachelor's degree:
Mother Only:
Father Only:
Both Parents:
Guardian Only:
No One:
I am registered with UNCG's Office of Disability Services.
* Please note if you are registered with UNCG's Office of Disability Services, you have the option to authorize the LAC to contact your DS counselor. Your request will not be hindered should you choose not to authorize contact. Please indicate below.
I hereby authorize the Learning Assistance Center to contact the Office of Disability Services. I understand that I am authorizing contact with my personal counselor.
Are you willing to work in a group with another student during academic skills sessions?	Yes No
Please indicate if you are a graduate anesthetist student:	Yes No
Please indicate when you are NOT available:
Comments / Special Requests:
Referred by:
Statement of Certification: I certify that I am currently enrolled at UNCG.