Get Tutor-Mentor Program Application Form

These sessions may range from 1-2. 5 hours long depending on the site s need. Additional requirements include attending Questions or concerns Contact the CILCE office at 651-962-6800 or email us at tutormentor stthomas. Tutor-Mentor Program Application Form Center for Intercultural Learning and Community Engagement For Office Use Only Emailed Placed Database DUE DATE FEBRUARY 9 Please drop off completed form in the CILCE Center MHC 153 CILCE Office MHC 159 or Dean of Students Office ASC 241 Personal Information Please Print Name Full First Name Middle Initial Cell Phone Number Last Name Email Address UST ID number Year in School Freshman Sophomore Junior Senior Graduate Student Course Information Are you participating for Business 200 Yes Are you a Page Scholar If yes how many hours do you want this semester No If yes please list course name and professor This form must be approved and signed by course professor prior to submission to ensure the program meets course requirements if completing for credit other than BUS 200. Professor s signature Placement Questions Have you participated in the program before If yes how many semesters have you participated in the program Do you have a vehicle to drive yourself to a site If yes are you willing to drive other UST students to your assigned site Carpool drivers help make our program run* Thank you Please note the University of St* Thomas is not responsible for any liability. If you agree to carpool what is your vehicle s description Grade Preference Please list if you have a specific site request. No guarantees but we will try our best to accommodate Color Make Model K-3 4-6 7-8 9-12 Before/After-School Program Availability Please list times between 7 30am and 6 30pm Monday thru Friday. Please list available times in at least 3 hour increments so travel time can be incorporated* Day Available Times to Participate Monday Tuesday Wednesday Thursday Friday You must complete 10 sessions of Tutor-Mentoring over the course of the semester. Professor s signature Placement Questions Have you participated in the program before If yes how many semesters have you participated in the program Do you have a vehicle to drive yourself to a site If yes are you willing to drive other UST students to your assigned site Carpool drivers help make our program run* Thank you Please note the University of St* Thomas is not responsible for any liability. If you agree to carpool what is your vehicle s description Grade Preference Please list if you have a specific site request. If you agree to carpool what is your vehicle s description Grade Preference Please list if you have a specific site request. No guarantees but we will try our best to accommodate Color Make Model K-3 4-6 7-8 9-12 Before/After-School Program Availability Please list times between 7 30am and 6 30pm Monday thru Friday. No guarantees but we will try our best to accommodate Color Make Model K-3 4-6 7-8 9-12 Before/After-School Program Availability Please list times between 7 30am and 6 30pm Monday thru Friday. Please list available times in at least 3 hour increments so travel time can be incorporated* Day Available Times to Participate Monday Tuesday Wednesday Thursday Friday You must complete 10 sessions of Tutor-Mentoring over the course of the semester.