Volunteer Tutor contact formPlease complete and submit the contact form below. This form is ONLY to be completed during or after the orientation session. * Indicates a required field. Name: * Address: * City * Zipcode * Best Contact Phone Number * 555-555-5555 Birth date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Education: * GED High School Diploma College: - None - College 1 year College 2 years College 3 years College 4 years College 5 years College more than 5 years College more than 6 years Lnumber Email address: * Preferred location: * Downtown Campus Main Campus Other Please check the times that you are available to tutor: * Monday a.m. Tuesday a.m. Wednesday a.m. Thursday a.m. Friday a.m. Monday afternoon Tuesday afternoon Wednesday afternoon. Thursday afternoon Friday afternoon Monday evening Tuesday evening Wednesday evening Thursday evening Please prioritize your placement choices: * first choice second choice third choice ASD/GED Classroom Assistant * ASD/GED Classroom Assistant - first choice ASD/GED Classroom Assistant - second choice ASD/GED Classroom Assistant - third choice ASD 1/1 Tutoring * ASD 1/1 Tutoring - first choice ASD 1/1 Tutoring - second choice ASD 1/1 Tutoring - third choice ESL Classroom Assistant * ESL Classroom Assistant - first choice ESL Classroom Assistant - second choice ESL Classroom Assistant - third choice ESL 1/1 Tutoring * ESL 1/1 Tutoring - first choice ESL 1/1 Tutoring - second choice ESL 1/1 Tutoring - third choice ESL small group Tutoring * ESL small group Tutoring - first choice ESL small group Tutoring - second choice ESL small group Tutoring - third choice Math * Math - first choice Math - second choice Math - third choice By checking this box, I agree to the requirements presented in the FERPA information at Orientation: * Why do you want to tutor? * Have you taught or tutored in the past? * Have you taught or tutored adults in the past? * Are you willing to donate at least 2 hours per week for three months? * How did you find out about this program? What are some of your skills that will be an asset to your tutoring? * Is volunteering for us a requirement of some other program you are participating in? * Have you ever had to turn in a time sheet? * yes no Self Rating: On a scale of 1- 5, how do you rate yourself? (5 is the most) * 5 4 3 2 1 How do you rate yourself on reliability? * How do you rate yourself on reliability? - 5 How do you rate yourself on reliability? - 4 How do you rate yourself on reliability? - 3 How do you rate yourself on reliability? - 2 How do you rate yourself on reliability? - 1 Do you feel you are a self-motivated person? * Do you feel you are a self-motivated person? - 5 Do you feel you are a self-motivated person? - 4 Do you feel you are a self-motivated person? - 3 Do you feel you are a self-motivated person? - 2 Do you feel you are a self-motivated person? - 1 Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) * Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) - 5 Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) - 4 Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) - 3 Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) - 2 Responsibility? (Keeping appointments, calling in advance when cancellation is necessary, returning messages, etc.) - 1 Is there anything else you would like me to know about you? Please list one reference below. This can be a teacher, friend or employer.: Name of reference: * Relationship to you: * Reference phone: * Leave this field blank
