APPLICATION FOR TUTOR AMBASSADOR SCHOLARSHIP
Name:
Student I.D. #
Email Address:
Birthdate:
Local Address:
Local Telephone Number:
Permanent Home Address:
Permanent Home Phone:
Cell Phone:
Major area of interest/study in college:
I AM APPLYING TO TUTOR THESE SUBJECTS:
1.
2.
3.
I WOULD ALSO BE ABLE TO TUTOR THESE SUBJECTS IF NEEDED:
4.
5.
Semesters I will be available to tutor: Fall _____ Spring _____ Summer ____
I would prefer to tutor at (circle one):
Andover
Classification (circle one):
Sophomore
Freshman
Tutor Ambassador Application
El Dorado
March 23, 2015
Page 1
Do you have previous tutoring experience?
Why do you want to be a Tutor Ambassador?
How will this position help your career interests or goals?
TO BE ELIGIBLE, ONE MUST MEET THE FOLLOWING REQUIREMENTS:
1. Knowledge in subject specialty and course requirements. As demonstrated by academic
record with a minimum GPA of 3.00.
2. Strong oral and written communication skills.
3. Strong leadership skills and self-initiative.
4. Strong computer skills.
5. Two Tutor Ambassador Reference Forms required, with at least one from an instructor in
the subject specialty addressing knowledge and interpersonal skills.
I understand that I will be required to sign a Tutor Ambassador Scholarship Agreement.
I HEREBY AFFIRM THAT THE ABOVE INFORMATION IS ACCURATE AND I WILL
FURNISH A COPY OF MY TRANSCRIPTS IF REQUESTED.
Date of Application:
Signature:
FALL Deadline: May 1st
SPRING Deadline: December 1st
Tutor Ambassador Application
March 23, 2015
Page 2
Tutor Ambassador Reference Form
Thank you for completing this Tutor Ambassador Reference Form. These references weigh heavily
when we are choosing a Tutor Ambassador for your subject area(s).
APPLICANT’S NAME (print):
Date completed by applicant:
/
/
*sign one of the next two options:
I request that this reference form remain confidential
I do not waive my right to review my personnel file
The person named above has applied to be a Tutor Ambassador. We would appreciate your candid
assessment of the candidate’s potential ability to tutor his or her peers. Please use the lower portion
of the second page to expand on any answers as necessary.
1. Applicant’s knowledge of subject material (circle one): Thorough
Moderate
Low
2. What course(s) has the applicant studied with you?
3. What course(s) do you feel the applicant can effectively tutor:
4. Is this applicant able to clearly and imaginatively communicate the subject to others?
5. Please rate the applicant’s patience:
6. Is the applicant personable:
7. How dependable is this applicant:
Extremely Patient
Extremely
Extremely
Moderately So
Moderately So
Moderately
Impatient
Not Personable
Not Dependable
8. How long have you known the applicant:
9. In what capacity?
10. Can the applicant effectively juggle multiple time/priority demands (civic, work, school,
family, etc.)?
Extremely Well
Moderately Well
Not A Good Juggler
Tutor Ambassador Application
March 23, 2015
Page 3
We appreciate any and all information that you feel is relevant in assessing the applicant’s tutoring
skills or potential. Please explain why you feel this applicant is the best person for a Tutor
Ambassador with Butler.
Subject Area(s) Taught
Faculty Signature
Date Completed
Please return completed form to:
Shannon Covert
Associate Dean, Academic Support Services and College Readiness
Butler of El Dorado, Room 651
901 S. Haverhill Road
El Dorado, KS 67042
316-322-3167
Email: scovert@butlercc.edu
Tutor Ambassador Application
March 23, 2015
Page 4
Tutor Ambassador Reference Form
Thank you for completing this Tutor Ambassador Reference Form. These references weigh heavily
when we are choosing a Tutor Ambassador for your subject area(s).
APPLICANT’S NAME (print):
Date completed by applicant:
/
/
*sign one of the next two options:
I request that this reference form remain confidential
I do not waive my right to review my personnel file
The person named above has applied to be a Tutor Ambassador. We would appreciate your candid
assessment of the candidate’s potential ability to tutor his or her peers. Please use the lower portion
of the second page to expand on any answers as necessary.
1. Applicant’s knowledge of subject material (circle one): Thorough
Moderate
Low
2. What course(s) has the applicant studied with you?
3. What course(s) do you feel the applicant can effectively tutor:
4. Is this applicant able to clearly and imaginatively communicate the subject to others?
5. Please rate the applicant’s patience:
6. Is the applicant personable:
7. How dependable is this applicant:
Extremely Patient
Extremely
Extremely
Moderately So
Moderately So
Moderately
Impatient
Not Personable
Not Dependable
8. How long have you known the applicant:
9. In what capacity?
10. Can the applicant effectively juggle multiple time/priority demands (civic, work, school,
family, etc.)?
Extremely Well
Moderately Well
Not A Good Juggler
Tutor Ambassador Application
March 23, 2015
Page 5
We appreciate any and all information that you feel is relevant in assessing the applicant’s tutoring
skills or potential. Please explain why you feel this applicant is the best person for a Tutor
Ambassador with Butler.
Subject Area(s) Taught
Faculty Signature
Date Completed
Please return completed form to:
Shannon Covert
Associate Dean, Academic Support Services and College Readiness
Butler of El Dorado, Room 651
901 S. Haverhill Road
El Dorado, KS 67042
316-322-3167
Email: scovert@butlercc.edu
Tutor Ambassador Application
March 23, 2015
Page 6