Section A
Choose which semester you are applying for: Fall Spring
Please indicate preference for grade level by numbering 1, 2, and 3 Elementary 1 2 3 Middle 1 2 3 High 1 2 3
If Elementary is your highest preference, please choose a site from this list Annie Fisher Rawson Martin L. King Mark Twain UH Magnet
Please enter your name: First MI Last
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Home Address: Street City State Zip Code
Local Address: Street City State Zip Code
E-mail Address:
Best time(s) to reach you:
Social Security Number: - -
Please indicate if you are a new or returning tutor: New Returning
If you are a returning tutor please list which semesters you have tutored for EMS:
Section B (Please answer all questions)
Choose One: Freshman Sophomore Junior Senior Graduate Student Other
If you are not a student please tell us how you heard about EMS.
What is your major?
Which college are you enrolled in?
Are you volunteering for a University of Hartford class? Yes No
If yes list the course(s), professor(s), and number of hours required for the semester. Course Professor Hours Required Course Professor Hours Required Course Professor Hours Required
