Huckleberry Wellness Academy – San Francisco TUTOR APPLICATION

Huckleberry Wellness Academy – San Francisco TUTOR APPLICATION
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Number of years at the above address?
Number of years living in the Bay Area?
Do you speak any languages in addition to English?
Employer Information
Current Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Job Title
Education
What is your highest level of education?
Are you currently a student?
(If applicable) School/program:
Do you have any special training, credentials or licenses that would be relevant in working with youth? Please explain:
Youth Experience
Do you have any previous experience working with youth? If so, please explain:
Tutoring
Why would you like to be a tutor?
Do you have any previous tutoring experience? If so, please explain:
Please rank your competency/comfort level with the following subjects: (1 being very uncomfortable, 10 being very competent/comfortable)
English
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
U.S. History
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
World History
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Basic Algebra
Advanced Algebra
Geometry
Pre-Calculus
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Calculus
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

AB APBC AP
Biotechnology
Statistics
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Computer Science
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Environmental Science
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Chemistry
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Biology
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
Physics
Please indicate whether you would feel comfortable tutoring an advanced version of this course.

HonorsAP
SAT: Verbal
SAT: Math
SAT: Strategy
Language other than English?
What level can you tutor up to?
Please elaborate on above ratings, if necessary:
If chosen, how long could you commit to being a tutor?

Less than 1 semester1 semester1 academic yearMore than 1 academic year
Please comment, if necessary:
TIMES AVAILABLE:

Please place a mark in all the time slots when you could be available for training and/or to meet with a student
MultiSelect Grid
References

Please provide complete information for three persons who have known you for at least two years and can vouch for your character, reputation and dependability. Please include one employment reference. If you have tutoring experience, please include one or more reference that can speak specifically to your effectiveness as a tutor.
1. Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Nature of Relationship
Number of years acquainted
2. Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Nature of Relationship
Number of years acquainted
3. Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Nature of Relationship
Number of years acquainted
* Please read carefully and thoroughly before signing *

I submit that the above information is true and accurate and that I have answered all questions to the best of my ability. I will cooperate in every way with the Huckleberry Youth Programs’ Volunteer Program to meet the necessary screening requirements, including: an in person interview, fingerprint clearance by the California Department of Justice, and proof of TB Test.

I give permission to the Huckleberry Youth Programs to contact the references provided. I understand that the information received from the references will remain confidential.
Signature*

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Huckleberry Wellness Academy – San Francisco TUTOR APPLICATION

Employer Information

Education

Youth Experience

Tutoring

Please rank your competency/comfort level with the following subjects: (1 being very uncomfortable, 10 being very competent/comfortable)

References