| Name |
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| Student ID Number |
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| Email |
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| Phone |
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| Class Year |
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| Major: |
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| Do you have Work Study? |
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| MAXIMUM HOURS/WEEK YOU ARE AVAILABLE FOR TUTORING: |
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| BILINGUAL FLUENCY? |
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| LANGUAGE(S) SPOKEN? |
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| ARE YOU A DESIGNATED DRIVER? |
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| WOULD YOU BE WILLING TO BECOME A DESIGNATED DRIVER? |
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| WHICH SUBJECT DO YOU FEEL YOU CAN TUTOR IN:
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| 1. Please state your tutoring experience. Also state your experience with community, campus, or other social organizations: |
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| 2. Please state your reasons/motivations for becoming a Tutor: |
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| 3. Please state your strengths and weaknesses in relation to working with underrepresented students (low-income, first generation college bound): |
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| 4. Please state any Other Skills (hobbies, talents) that may be useful as a Tutor: |
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| What days and times are you available to work? |
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| Which program Would you like work in? |
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| Which GEAR UP School? |
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| Image Verification |
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