Portland Community College/Sylvania

PEER TUTOR APPLICATION

Personal Information Student ID #____________________

Name: ___________________________________________________________________________________ Last First Middle

Address: _________________________________________________________________________________

E-mail Address: __________________________________________ Phone #__________________________

Educational Information

1. What subjects do you want to tutor?

_____________________________

_____________________________

_____________________________

2. Please provide a list of courses you have taken that you feel you can tutor. Indicate your grade for each class and provide your cumulative GPA in the space provided.

Class

Year/Term Taken

Grade

Cumulative GPA _____

3. Please provide a current resume.

References

List at least 2 current references. At least one reference must be an instructor from a subject area you wish to tutor.

Name Title/Position Address Phone Relationship

_________________________________________________________________________________________

_________________________________________________________________________________________

I, ______________________________, authorize Tutorial Services to contact individual references listed above.