Carver Center/ Coachman Family Center/ White Plains Youth Bureau

TUTOR APPLICATION FORM (Note: Please verify your FWS status with Financial Aid before applying)

Class: FR / SO / JR / SR Today’s Date: ________________

ID# ______________ FWS? YES / NO

Name: _____________________________________ Campus E-mail : ______________________@mville.edu

Campus Ext: ___________ Cell Phone: _________________________Home: _________________________

Permanent Home Address: ______________________________________________________________

______________________________________________________________

Tutoring Experience:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Employment History: (List position and responsibilities, or attach resume)

___________________________________________________________________________

___________________________________________________________________________

References: (Two references: Name and phone number of former employer, teachers or professors)

TRANSPORTATION NEEDED?

U.S. DRIVER’S LICENSE?

SCHEDULE – Please select the position(s) you are applying for and circle the days of the week you are available to work for the entire semester

Coachman Tutor (Work hours: 3:15PM-5:45PM):

Carver Tutor (Work hours: 2:45PM-6:15PM):

Coachman Tutor/Driver (Work hours: 2:15PM-6:45PM):

WP Youth Bureau Tutor (Work hours: 9:30AM-3:30PM):

M T W Th F (At least 2 days a week) M T W Th F (At least 2 days a week) M T W Th F (At least 2 days a week) SATURDAYS (WPYB-Saturday Academy)

Revised: