Name

Email Address (SENDER) (You must provide a valid email address)

Gender: Male Female

Class Freshman Sophomore Junior Senior Graduate Major

Academic College (Pick one) Arts and Sciences Education Business and Economics Engineering and Applied Sciences GPA

Mailing Address

City State Zip

LOCAL Phone

Cell Phone


Ethnicity African American/Black Hispanic/Latino Caucasian Asian Other

How many years have you been with S.T.A.R. Academies? New One Two Three Four Five Six Seven or More

Name of Parent(s)

Address

City State Zip

Are you a vegetarian? Yes No

What is your LU meal plan? 5 10 19 Other

1. How did you find out about this program? Please check
Friend or roommate Advertisement Other

2. What specifically do you have to offer to the students in this program?

3. Have you had any prior experience in tutoring students? Please be specific (e.g. age level of student(s); subject(s), length of time)

4. If you are a returning tutor, why have you decided to sign up again to participate in the Academy?

5. What grade level(s) would you prefer to work with?
8th Grade 9th Grade 10th Grade 11th Grade 12th Grade No Preference

6. If you are a returning tutor and your tutee from last year participates, do you want to work with him/her again? Why or why not?

7. What are your intended career goals?

8. Are there any other careers of interest to you?

9. What sports/hobbies are you interested in?

10. Please list your extracurricular activities during the 2011-2012 academic year and the time commitment required.

11. Will you be available to attend a Tutor/Mentor training session on Saturday, October 20, 2012 from 10:00 a.m. to 3:00 p.m.? This session will be for returning and new tutors. (breakfast and lunch will be included)
Yes No

12. It is very crucial for Tutor/Mentors to attend all program dates. Can you attend all S.T.A.R. dates listed on our site?
Yes No