AHS PEER TUTOR APPLICATION

Please complete this application and submit it to Mr. Wang in H-10 by September 8. The information submitted on
this application will remain confidential.

Name: _____________________________ ID #: __________ Grade Level (’10-’11): ______

Mobile phone (or parent mobile):___________________ Home phone:__________________

E-mail address: ________________________________ Estimated GPA (un-weighted):_____

Courses taken in… Class Grades Received

English

Math

Foreign Language

Science

Other (optional)

Schedule for the ’10-’11 School Year (where applicable)

Period Subject Teacher Room
0
1
2
3
4
5
6
7

1. Please briefly state why you wish to be a peer tutor. What do you believe are important
qualities for peer tutors to possess?
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__________________________________________________________________________

__

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2. What extra curricular commitments would prevent you from tutoring on a consistent
basis? (Competitions, sports, meetings, etc.)

__________________________________________________________________________

__________________________________________________________________________

__

__________________________________________________________________________

3. What subjects can you tutor? Why?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__

4. Will you need to take a leave of absence this year, and for what? (APs, finals, etc.)

__________________________________________________________________________

__________________________________________________________________________

__

5. Are you interested in tutoring at the middle schools with the Outreach Program?

 Yes  No
6. Which day(s) of the week would you be available to commit to peer tutoring, for one
hour after school from 3-4 PM? Please check all that apply.
  Monday  Tuesday  Wednesday  Thursday

For Office Use Only: Y: N:

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