Your Title:

Your Name:

Email Address:

Name:
(Enter your name as you would like it on your tutor certificate if different from above.)

Date:

Address:

City:

State:

Zip:

Home Phone :

Alternate Phone:

Occupation:

Employer:

Age (must be at least 18):

Birth date:

Gender:

How did you hear about us?

If referred by an MLC volunteer, who?:

Ethnic Origin :

Please select the highest level of education completed:

Other organizations you are active with:

I will attend the Tutor Training Workshop in the month of:

Computer Skills:

Do you have experience teaching groups?

Additional skills, talents, and hobbies:

Briefly, why would you like to be a volunteer tutor?

All tutoring takes place at 902 South Cooper. The following times are available for tutoring: Mornings - 9 am to 1 pm M, T, W, Th, F, S; Afternoons - 1 pm to 4 pm M, T, W, Th, F; Evenings - 4 pm to 9 pm M, T, W, Th.

Please list, in order of preference, two or three times which fit your schedule. This information will help our program coordinators match student and tutor schedules.

Tutor training workshops are held on the second floor of our building. If you require special accommodations, please notify us in advance at 327-6000. Thank you.

You will receive a letter by mail confirming your registration and a reminder call one week before training. Please call 327.6000 for further information.

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