EMS Application

Date: Semester:

Name:

Cell#:

U of H Box #:

Major: in the College of:

Home Address:

E-mail:

Best time to reach you:

Select one: Previous Tutor New Tutor
School you tutored At:

Do you want to return to the same school? Yes No

Tutoring For Professor:
Hours (#):
Volunteer
Work Study
Other (please specify in comment box)
Class Credit (specify in comment box)

Do you need transportation? Yes No

Subjects:
Language Arts/English
Foreign Language
Reading
Mathematics
Computers
Arts
Science
Special Education

Have you ever been convicted of a Felony? Yes (specify in comment box) No

Schedule (Day and Time):




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