Tutor Application form

First Name *

Last Name *

Date of birth *

Lawrence ID *

SPC #: *

Race/Ethnicity ***

Gender ***

*** The VITAL Program asks Lawrence tutors for their racial/ethnic identity, foreign language fluency, and their gender identity to accommodate for the requests of the tutee’s families. This is a part of our effort to best match students together. You are not obligated to answer any of these questions.

Email address: *

Year at Lawrence *

Grade range *

Kindergarten - Grade 5 (Elementary)

Grade 6-8 (Middle School)

Grade 9-12 (High School)

Subject Preference (Select as many as you wish) *

Disclaimer: We are no longer offering tutoring in high school math

Special Requests

Are you able to tutor a subject in a foreign language? (e.g. Teach history in Spanish) *

Yes

No

If yes, what language and what subject?

Have you previously been a VITAL Tutor? *

Yes

No

Previous Tutee's Name and Subject:

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

Yes

No

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

I FULLY commit to following the next steps of the VITAL program that will ensure that all of our tutees are having the most productive and academically effective sessions as possible. *

I FULLY commit

Date *

Year

Month

Day

Signature *

Sections

Apply to Become a VITAL Tutor