Educational Supportive Services
201 Holton Hall
Kansas State University
Manhattan, KS 66506
p
(785)532-5642
Tutor Application
Please read and answer questions completely in legible print Submit to receptionist or mail to the above address.
Date:
Social Security #:
Name:
-
-
(Ml)
(First)
(PRINT) (Last Name)
Permanent Address:
Local Address:
(If Different)
Local Phone: (
)
-
.
Permanent Phone: f
)
E-mail:
SO
JR
SR
Classification: GR.
FR
GPA (cumulative):
GPA( major):
Academic Major: _
Are you currently enrolled? Yes.
If yes, how many credit hours?
No
If a graduate student, do you have a graduate assistantship? Yes
Do you qualify for the College Work Study Program? Yes,
No
No
What department?
How much is your eligibility?
If you have applied for financial assistance (work study, supplemental grants, or national student loans), employment with ESS may affect your needbased eligibility. Check with your financial aid advisor.
List any previous volunteer or paid tutoring experiences, subjects tutored, and how long.
What languages do you speak fluently, write, and understand?
TOEFL Score?
Date Completed
Where?
We prefer applicants to have successfully completed courses with an "A" or "B" at Kansas State University. List all
subjects individually according to your preference in tutoring. (Please attach additional subjects on a separate sheet).
Course(s) and #, ex: Math 100, Stat 350
1.
2.
3.
5.
6.
7.
4.
Please list two names, addresses, and phone numbers who will provide references for your academic and/or work
experience. We prefer KSU faculty or staff as references.
Name:
Address:
Phone:
Name:
Address:
Phone:
The information that I have given on this application is true and correct to the best of my knowledge. I hereby give my consent for Educational
Supportive Services to verify my academic record from the Office of Admissions and Records at Kansas State University. (Only applications signed
below will be considered for employment).
Date
Signature
08/09/05 - Office use only:
Date received
Called for an interview.
Interviewer initials.
Hired_
Funding sources.
FALL / SPRING SCHEDULE FOR TUTORS
NAME
DATE
HOME PHONE
LOCAL ADDRESS
PERMANENT ADDRESS
SOCIAL SECURITY NUMBER
What is the maximum number of hours you would like to tutor each week?
Mark an X in aM the time slots that you are available to work regardless of the maximum number of hours you
indicated. Mark more hours than you desire to work to give the staff more flexibility in matching tutor and tutee
schedules.