VITAL Tutor Request form

This form is for the parents of tutees to apply to the VITAL Tutoring program. Please fill out each field so we can accurately match your student with an appropriate Lawrence Tutor.

Lawrence students wishing to be a tutor, please complete the VITAL Tutor Application Form.

Student's First Name: *

Student's Last Name: *

Guardian's First Name: *

Guardian's Last Name: *

Primary Phone Number: *

Please include area code.

Other Phone Number:

Please include area code.

Email Address: *

Student's Grade Level: *

Tutoring Subject: *

Current School: *

Short description of student in need of tutoring *

(ex: likes music, sports, favorite activities or dream job):

Special Requests:

Today's Date: *

Year

Month

Day

How did you find out about VITAL? *

Teacher/referral

Friend/colleague

VCSC advertisement

Other

Are you applying to VITAL because of the financial committment involved with other tutoring programs? *

Yes

Your answer will not influence your ability to get a tutor. This information helps us justify our program.

Thank you! The VITAL Tutoring Program coordinator will contact you soon.

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VITAL Tutor Request form

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