Mount Mercy College
Department of Criminal Justice
Academic Achievement Verification of Assistance Form
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Directions: Please print out this form and return completed to instructor.

Date of Assistance:     ___________________________________

Student Name:            ___________________________________

Class:                          ___________________________________
(for which you are receiving assistance)

Professor:                    ___________________________________
(of class for which you are receiving assistance)

Tutor Name:                ____________________________________

I hereby attest that the above student has visited and received assistance at the Academic Achievement Center at Mount Mercy College.

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Student Signature                       Date                                                       

__________________________________
Mary Jean Stanton                    Date

OR

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Nancy Rhodes                           Date