Tutor Applicant Information
Date
*
-
Month
-
Day
Year
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Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
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Age
*
Gender
*
Please Select
Male
Female
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Job
*
Education
*
Technical Knowledge
*
Please Select
Yes
No
Basic knowledge of computers.
Do you have available transportation?
*
Please Select
Yes
No
When are you available?
*
Are you available during winter?
*
Please Select
Yes
No
Do you have a criminal record?
*
Please Select
Yes
No
This includes misdemeanors and felonies.
Please explain
*
Learner Preference
*
Please Select
Male
Female
Either
Second Language
Would you be willing to tutor a student whose second language is English?
*
Please Select
Yes
No
Would you be willing to tutor a student with a felony or other criminal record?
*
Please Select
Yes
No
Would you be willing to tutor a developmentally disabled student?
*
Please Select
Yes
No
Anything else you would like us to know about you?
Please read: We are an alcohol, drug, and weapon-free organization. You are expected to keep all of the appointments made with your client. If you are unable to meet, you must call your client ahead of time and cancel. We reserve the right to deny participation in literacy project services.
I agree to these rules and verify that the information I am submitting is to the best of my knowledge.
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