Tutor Application Form :: Notre Dame Learning Center

Contact the Learning Center

Download this form as a Microsoft Word file to mail, e-mail, or fax in.

PLEASE SUBMIT THE FOLLOWING INFORMATION

Name SS#

Address City ST Zip

Phone: (585) Cell: (585) Email:

Emergency contact:

Name Relationship

Address City ST Zip

Phone (585) Cell (585) Email

Place of work:

Company name

Address City ST Zip

Phone (585) Email

References:

You may contact (#1):

Address City ST Zip

Phone: (585) Cell: (585)

You may contact (#2):

Address City ST Zip

Phone: (585) Cell: (585)

Tutoring opportunities:

Your area of interest Math Reading

Age/grade level: Primary (1-3) Secondary (4-8)

Please share your availability: Monday Tuesday Wednesday Thursday Friday

Confidentiality:

I agree to respect the confidentiality under which the Center operates, at all times.

Click to send this information or click return to previous page.

FOR OFFICE USE ONLY

Date of application _________________ Day(s) of Tutoring ________________________________

Time _____________ Name of Student _______________________________________________

Version 06-16-08 | web