Student Tutor/Mentor Application
| PLEASE PRINT THIS APPLICATION, COMPLETE, AND RETURN TO THE
FOLLOWING ADDRESS: EMPORIA STATE UNIVERSITY |
___________________________________________________________________________________
(Name) (SS#) (Telephone)
___________________________________________________________________________________
(Street Address) (City) (State) (Zip) (E-Mail)
ACADEMIC INFORMATION
Currently enrolled at ESU? _________ Number of hours this
semester? ______ Classification______
(No/Yes)
Graduation Date _____________ Major _______________ Minor _________ Major G.P.A._____
List activities and/or organizations which you have been involved in (campus and community):
____________________________________________________________________________________
____________________________________________________________________________________
TUTORING
List relevant tutoring experience, if any:
____________________________________________________________________________________
____________________________________________________________________________________
Please list all classes under each heading in which you feel qualified as a tutor/mentor. Indicate all classes and final grade received: (Grade of "B" or better is required.)
ARTS:
MATHEMATICS:
BUSINESS:
BIOLOGICAL SCIENCES:
PHYSICAL EDUCATION:
COMMUNICATION:
PHYSICAL SCIENCES:
ELEMENTARY EDUCATION:
PSYCHOLOGY:
FOREIGN LANGUAGES:
SOCIAL SCIENCES:
THEATRE:
OTHER:
What is your definition of a "high-risk" student? ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
What has your college education meant to you? ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
How will this position add to your educational experience? ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Describe any other work/school experience which you feel qualifies you for this position: ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Are you eligible for Work Study? Yes ______ No ______
I hereby authorize a copy of my college transcript be available to Project Challenge. This is to be used for evaluation purposes only and will be held in the strictest confidence.
_________________________________________________ ________________________
Signature Date
| PLEASE BE SURE TO SCHEDULE AN INTERVIEW APPOINTMENT WHEN RETURNING APPLICATION AND TWO LETTER OF REFERENCE. |
Last Updated April 30, 2007