When and how do you prefer to be contacted Can you speak, read or write other languages?Spanish: Chinese: Japanese: Korean: Vietnamese: Other (Please state): Read: Write:
Education: Please indicate highest grade completedHigh School___ Some College___ College___ Graduate School___
Occupation:
Employer:
Volunteer experience:
What experiences or interests do you have that might relate to tutoring?
What are your reading interests?
What are your hobbies/talents?
When would you be available for tutoring? Please note: your commitment to the learner you are paired with is crucial to his/her developing skills. Please be realistic in marking your availability. Put the hours next to A.M. or P.M. Sun. Mon. Tues. Wed. Thurs. Fri. Sat. A.M. A.M. A.M. A.M. A.M. A.M. A.M. P.M. P.M. P.M. P.M. P.M. P.M. P.M.
In what areas of service would you be willing to volunteer? One-on-one tutoring Office assistance Assessment of learner progress Matching tutors and learners Computer skills Training
Please indicate any other skills or experience that you would be willing to share with the program:
In a brief statement, please state why you would like to become a tutor:
Age: 15-19: 20-29: 30-39: 40-49: 50-59: 60-69: 70-79: 80+:
Racial/ethnic background: Asian: Black: Hispanic: Native American: Pacific Islander: White: Other :
Birthday:(day and month)
