| Education/Background (Indicated name of school/location and years completed): * |
| High School:
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| College:
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| Degree(s):
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| Other areas of study: |
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| Do you have any special skills or training that will aid in the development of our students? |
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Yes
No
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| Other skills and/or training (If yes, please explain): |
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| What were your grades in subject areas? |
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| Describe any prior tutoring experience: |
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| Grade Levels Qualified to Tutor: |
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K
1-5
6-8
9-12
College
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| Do you have materials to tutor with? |
Yes
No
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| Professional References (Name, Phone #, Years Known) |
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| Personal References (Name, Phone #, Years Known) |
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| Official Background Information: |
| Have you ever been convicted of any crime, whether a misdemeanor or felony? * |
Yes
No |
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| If yes, when, where, and for what crime? |
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| Will you agree to a drug test if necessary? |
Yes
No |
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| Will you agree to a background check if necessary? |
Yes
No |
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| Do you agree to a background investigation including a criminal background investigation? |
Yes
No |
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| When was your last background check performed? (Date, and By Whom?) |
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| What subject areas are you qualified to tutor? * |
English
Math
Science
History
Reading
Writing
Foreign Language
Study Skills
Other (specify)
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| Please enter the days and times you are available to tutor: |
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| Would you be willing to put an APT decal on your car for additional pay? |
Yes
No |
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