About Heads Up What We Do Our Impact Support Us

How We Serve Elementary Students | How We Serve College Students | How We Serve Parents

Tutor Application

Serve

Tutor Application

Personal Information

First Name*

Last Name*

Email*

Cell Phone

Social Security Number

Date of Birth*

Race/Ethnicity

School Address

Address 1

Address 2

City

State

Zip

Phone

Permanent Address

Address 1*

Address 2*

City*

State*

Zip*

Phone*

Emergency Contact Information

Name*

Relationship*

Day Phone*

Evening Phone*

University Information

University*

If other, please give university name*

Graduation Year*

Do you have a federal work-study grant?*

Yes No

If yes, please give total grant amount*

Are you receiving academic credit for your participation with Heads Up?*

Yes No

If yes, please give class name and number*

Previous Volunteer Work with Heads Up

Are you a returning tutor with Heads Up?*

Yes No

If yes, what site?*

Semester/Yr you first began?*

Experience, Skills and Interests

What (if any) previous experience do you have with tutoring, mentoring or service work?*

What about Heads Up interests you?*

What do you expect to learn while working this year as part of Heads Up?*

Please list any languages you speak and level of proficiency - beginner, intermediate or fluent*

Schedule

Please block out your class schedule and other ongoing commitments* (check the days and times you are unavailable)

	Mon	Tue	Wed	Thu	Fri
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
7 p.m.
8 p.m.
9 p.m.

The Heads Up program operates Monday-Friday, 3:00-6:30 p.m. Tutors attend for the full three-and-a-half hour period. Please indicate which days you prefer to tutor.* (Remember to give yourself travel time to get to the site.)

(CTRL-click to select more than one)

What other extracurricular activities are you involved in this year?

How many hours each week do you commit to other community service related activities?*

Other Information

How did you hear about Heads Up?*

If other, please enter how you heard about Heads Up*

If you are new to Heads Up and have been in contact with anyone from Heads Up (staff, AmeriCorps member, or tutor) please enter their name and site affiliation.

* Required field