Leasure Hall Tutoring Center
DATE:
Daytime Tutor Application
Applicant Information
Full Name:
SS #:
Last
First
M.I.
Address:
Street Address
Apartment/Unit #
City
State
Phone:
ZIP Code
Email
INDICATE SEMESTER APPLYING TO TUTOR FOR:
CLASSIFICATION:
GR
SR
SPRING
JR
SO
SUMMER
FALL
FR
ACADEMIC MAJOR:
GPA (CUMULATIVE):
Are you currently enrolled as a Kansas
State University student?
GPA (LAST SEMESTER):
YES
NO
YES
NO
YES
NO
Are you enrolled in at least 6 credit hours?
YES
If GR, are you currently employed as a
graduate teaching or research assistant?
NO
Are you currently on work study?
Previous Employment
Please provide the following information for your TWO most recent jobs.
Name of Employer:
Dates Employed:
Position:
Duties:
Supervisor Name:
Phone Number:
Name of Employer:
Dates Employed:
Position:
Duties:
Supervisor Name:
Phone Number:
1
Maximum number of hours you can work each week: _____________
Place an X in the time slots you are NOT available to tutor
HOURS
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
8:30-9:20 AM
9:30-10:20 AM
10:30-11:20 AM
11:30-12:20 PM
12:30-1:20 PM
1:30-2:20 PM
2:30-3:20 PM
3:30-4:20 PM
4:30-5:20 PM
List the courses you would like to tutor by course number (PHYS 110), and mark the grade you
received in that course next to it.
COURSE
COURSE
GRADE
GRADE
Briefly state below why you want to tutor and identify characteristics you think are important to
being an effective tutor.
Disclaimer and Signature
This is to certify that the information I have given on this application is true and correct to the best of my
knowledge (only applicants who sign below will be considered for employment). I hereby give my consent for the
Academic Assistance Center to verify my academic record with the Registrar’s Office at Kansas State University.
Signature:
Date:
Please return completed form along with a DARS Report to Kimberly Dierks, M. Ed., Coordinator
201 Leasure Hall, (785) 532-5703
2