Tutor Application form

VITAL Tutoring Program Application

If you would like to apply to be a VITAL tutor, please fill in each field below and click the submit button once. If you prefer to complete a paper version of this form, please go here. Please note that this form is for Lawrence STUDENTS wishing to apply to be tutors.

If you are a parent seeking tutoring for your child(ren), please complete the form found here. Thanks for taking the time to apply!

The following will be reviewed by the coordinator of the VITAL Tutoring Program:

Name *

Lawrence ID *

Date of birth *

SPC #: *

Email address: *

Preferred Phone # : *

Why are you interested in being a VITAL tutor? *

Please explain expertise in music:

Please explain expertise in foreign language:

Age range *

kindergarten - grade 5

grade 6-8

high school

Would you like to work with your tutee from last year? *

yes

n/a

Previous Tutee's Name :

Have you ever been accused of any abuse or harmful action toward children? *

Yes

Your initial below indicates that all the information you provided is accurate. The LU Volunteer and Community Service Center will be sending you a criminal background check to fill out and return which is required to participate in the VITAL program.

Initial *

Date *

Year

Month

Day

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