Work-Study Tutor Form

Name:    UVID:    Email:
Cell Phone Number:    Other Phone Number:
Address:
City:    State:   Zip Code:

I would prefer to work with?
K to 6th Grade
Middle/Junior High/High School

Availability
Please mark the day(s) and time(s) you will be available: (Please check all that apply to which you can commit on any given day)
Monday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   

Tuesday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   

Wedesday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   

Thursday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   

Friday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   

Saturday

8-9am    9-10am    10-11am    11am-12pm    12-1pm    1-2pm    2-3pm   
3-4pm    4-5pm    5-6pm    6-7pm    7-8pm    8-9pm    9-10pm   



Regarding the above schedule:
How long can you commit to above hours per day? (i.e. for the semester, for what number of weeks, etc?)
How many hours a week do you prefer to work?  

Are you willing to accept orientation, training, and direct supervision from teachers, principal(s), and others involved in the program administration?   Yes      (please initial)

What subjects do you feel most comfortable tutoring? (select all that apply)
Elementary Core: Math    Language Arts/Reading    Social Studies    Science   
Math:Algebra     Algebra II    Geometry     Trigonometry     Pre-Calculus     Calculus    
Science:Physical Science     Biology    Physics     Chemistry     Anatomy     Physiology    
English:Writing     Literature    Grammar     English    
Social Science:U.S. History     World History    Geography     Psychology     Sociology    
Other:

What is your Major?:
How did you hear about us?:
What is the reason you want to be a tutor?:
Do you have reliable transportation?: Yes    No
How far are you willing to travel for work?: