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INSTRUCTIONS: For more detailed information please refer to the information contained in the PLA Budget Request Information.


1)   Individual instructors requesting PLAs for courses with one section and First-Year Seminars should use a Request Form for each course.

2)   Chairs or Department PLA Coordinators may use a single Request Form for the following:

  • a course with multiple sections: Example: Spanish 101 sections A&B
  • a group of courses with shared PLAs: Examples: Span 101, A,B; Span 103 A-E, and Span 104, A-D
  • departmental requests for "at-large" tutors available as needed for any course in the department

3)   Be sure to complete the entire form and click submit at the bottom of the screen.

4)   Send PLA names now if you know them, but do not delay sending the form if you do not.


Spring 2019

(*) denotes required information.

* Full Name:

* E-mail:

* Department:(FY Seminar list your home department)

Course Name(s), Number(s) and Section(s):

Total hours per week for this request:

Please check ALL that apply:
GDF: Group Discussion Facilitator (outside classroom)
SGF: Small Group Facilitator (inside classroom)
DI: Drop-in help (e.g., regularly scheduled 'office' hours)
TUT: One-on-one tutor
PRS: Practice/Review Session (outside of classroom)
O: Other (please explain below)

1. Please explain briefly how the Peer Learning Associate's duties relate to the course's/courses' goals.
If you are pasting text from Word, please paste as plain text.

2. New Requests: How will you evaluate the effectiveness of the Peer Learning Associate's involvement in the course(s)?
If you are pasting text from Word, please paste as plain text.

3. Renewed Requests: Summarize results of your most recent assessment.
If you are pasting text from Word, please paste as plain text.

Please check if you provided the “Student Survey on PLAs” to the students in classrooms with PLA coverage.