Tutor Application
Contact Information
Date of Application
Name
Address
City, State, Zip Code
Preferred Phone Number
E-Mail Address
Other Information
Position Applying For
____ Professional Tutor
____ Peer Tutor (students)
____ Work Study
List any/all degrees earned
Academic Major
(students only)
Current GPA
(students only)
Class Year (students only)
Do you have previous
tutoring experience?
____ Yes
____ No
Number of hours per week
you would like to work
Type of tutoring in which are you interested? – Check all that apply
During which hours are you available for volunteer assignments?
___ 1:1
___ Writing Center
___ Computer Lab
___ Small Group
___ Engineering Lab
___ Vet. Science Lab
___ Math/Science Center
___ Business/Accounting Lab
___ General Studies Lab
Courses in which you are interested in tutoring? – Please list course name and number
COURSE NAME
COURSE NUMBER
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from employment, previous volunteer work,
or through other activities, including hobbies or sports that you believe will help you to be a successful
tutor.
References – Professional Applicants only
(Students please use the Faculty Endorsement Form)
Name/Relationship
Contact Information
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that
if I am hired as a tutor, any false statements, omissions, or other misrepresentations made by me on this
application may result in my immediate dismissal.
Name (printed)
Signature
Date
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion,
national origin, gender, sexual preference, age, or disability.
Thank you for completing this application and for your interest in providing tutoring services
to SUNY Canton.
12/19/13