Intake registration

Registration Form

Please complete the form below and click the 'Submit' button when you are done. The 'Submit' button is located at the very bottom of this page.
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I would like to request services for: (Please check all that apply)
If requesting Disability Services, please complete the following information:

Do you have documentation of a disability?

Please submit your documentation to the LAC via fax 513-745-3387, email:, or mail: 3800 Victory Parkway Cincinnati, OH 45207-1131.

By submitting this form, I authorize the Learning Assistance Center to communicate with other offices and personnel that may be involved with my academic accommodations at Xavier. I understand that this communication will allow the LAC to better serve my needs. I certify that I have completed this form to the best of my ability and that all information is accurate.

If you are requesting tutoring, please complete the following information:

Please indicate the best environment for you to learn:

NOTE: If you are requesting a tutor for General Biology, General Chemistry, Anatomy & Physiology, Organic Chemistry, College Physics, or Music Theory, please attend the study sessions for these courses. The schedule is available at Please schedule a time to meet with Stephanie Daniels to discuss your needs in the course through the "Book an Appointment" module in ClockWork.

At times, there may be a waitlist for tutoring services and working with another student may help minimize the time you are on the waitlist. Therefore, you may be paired with another student in the same course.

By submitting this form, I agree to come to my tutoring sessions prepared with books, notes, syllabus, and other class materials. I also agree to be prompt to my appointments, and will contact MY TUTOR at least 24 hours in advance if I cannot make a scheduled appointment.

By submitting this form, I agree to the terms and conditions stated above.
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