Name:

Campus/Local Address:

Home/Summer Address:

Cell Phone #:

Home/Summer Telephone #:

Email Address:

Major:

Minor:

Which semester would you want to START working in the Center? (Give semester and year: i.e., Fall ‘13.)

What will your classification be at the start of that semester? (SOPHOMORE status required/minimum of 30 earned hours):

After that first semester, which other semesters would you be available to CONTINUE working in the Center?

When do you expect to graduate from Paine? (Give month and year)

Cumulative GPA (2.75 required)

Major Field GPA

List EACH subject area and specific subject in which you can tutor effectively (consider only those courses in which you earned at least a B):

Electronic Signature for Transcript Request

I give permission for the Director of Academic Support to request an updated copy of my official transcript from the Registrar’s Office.

YESNO

Initials

Student ID #

General Information

What activities, clubs, or school assignments will you be involved in that may require a lot of your time? (ex.: Senior Field Paper, student teaching, choir, student government, school trips, etc.)

If hired to work in Academic Support, will you also be working at another job, either on or off campus? YES NO If yes, give type of work, number of hours, and anticipated work schedule:

YESNO

Each semester, you will work a maximum of 10 hours per week. Do you think that your special activities or another job would interfere with you being able to work your designated number of hours per week?

YESNO

Explain

References

Click here to download a Peer Tutor Reference Form.

Please fill in your name and the semester for which are applying. Then give a hard copy of the form to each of the 3 references. Each of your references should send a HARD COPY of the completed reference form [with an original signature] to Academic Support. At least 2 of your references should be instructors in the areas in which you wish to tutor. Please complete the following information about your references so that we may know who will be returning forms to us.

Reference #1

Name

Position

Address

Telephone

Reference #2

Name

Position

Address

Telephone

Reference #3

Name

Position

Address

Telephone

NOTE: Each reference should send a hard copy of the completed form directly to Dr. Reid. You should submit your completed application online as soon as you are finished with it. Do not wait for your references to be returned. We can start to process your application while we are waiting for your references.

Write a paragraph stating why you would like to work in Academic Support. Include information about any prior experiences you have had as a tutor and explain how you could be an asset to the program.

Contact Information