TUTOR REGISTRATION

WHICH TUTOR*

Adult Tutor

Children and Parents Reading Together Tutor

Both

FIRST NAME*

MIDDLE INITIAL

LAST NAME*

GENDER

Male

Female

ADDRESS

CITY

STATE

ZIP CODE

HOME PHONE

CELL

EMAIL*

PLACE OF BIRTH

DATE OF BIRTH*

RESIDENT

Full-Time

Part-Time

Education

Bachelor*

Master*

Major*

Doctorate*

ADDITIONAL LANGUAGES *

HAVE YOU EVER BEEN CONVICTED*

Yes

Employment

Most Recent Employment

Company*

Position*

Dates*

Are you interested in helping Literacy Volunteers in a role other than tutoring? If yes, please specify the role:

Office Assistance

Event Assistance

List any groups/clubs you belong to, e.g., book clubs, tennis groups, etc.

Please give any additional information about yourself that may be pertinent to this role, including prior experience as a teacher or trainer.

CONFIDENTIALITY

Never give out personal information about a tutor, student, or volunteer.
Refer any request of information relating to LVCC tutors, students, or volunteers to the appropriate staff.
Personal information about a tutor, student, or volunteer should only be shared on a need to know basis.

As a tutor/student/volunteer for LVCC, I understand in the course of my service, I may learn information about students, tutors, volunteers, or staff which is confidential: e.g. finances, living arrangements. I understand all such information shall be treated as completely confidential even after I terminate my services with LVCC. I agree not to disclose any information of a personal and /or confidential nature to any person not authorized by LVCC to have such information, without specific consent of the individual to whom such information pertains. Failure to comply with this Confidentiality Agreement will result in release from affiliation with LVCC.

INITIALS

TUTOR STATEMENT OF INTENT

As an LVCC tutor, I agree to do my best to carry out the following tutor responsibilities:

Begin or schedule tutoring within two weeks after completion if training.
Agree to a minimum of one year of tutoring service to LVCC.
Maintain confidentiality.
Respect students' rights and understand their responsibilities.
Promptly complete time sheets and student attendance reports as requested.
Attend in-service training workshops and roundtables as requested.
Return all materials when I complete my tutor experience.

I have read, and understand, the responsibilities expected of me as a representative of LVCC.
I understand I will be contacted for a personal interview.

INITIALS

FIRST AND LAST NAME*

DATE*

SIGNATURE*

Your information will never be shared with any third party.

YOU MUST SEND THE APPLICATION FIRST. THEN, COMPLETE THE DONATION SECTION AND SUBMIT.

Please consider a $50 donation. Thank you!

This field should be left blank

TUTOR APPLICATION

Thank you so much for your interest in becoming a Tutor with LVCC. Please read carefully these instructions before completing your online application.

Fill out every field in the application form. You will get an error message if required fields are not completed.

Click SEND, once you complete the form.