Tutor Application

Academic Coaches Tutoring

Tutor Application

Contact Information

How did you hear about our Company? (Required):

*Tutor Name (Required):*
Address:
City, State & Zip:

*Home Phone (Required):*	Format = nnn-nnn-nnnn
Cell Phone:	Format = nnn-nnn-nnnn
Work Phone:	Format = nnn-nnn-nnnn
FAX:	Format = nnn-nnn-nnnn
DOB:	Format = mm/dd/yyyy

E-mail Address (Required):

Occupation/Profession Information

Current Occupation:
Current Employer:
Years Employed:
Looking for Full Time Employment?	Yes No

Education/Background Information

High School:
Degree from what College:
Post-Grad Degree College:
Other Areas of Study

Occupation/Profession Experience

List the areas/towns you would be willing to tutor in:

Distance/Driving time you are willing to travel from your home address:

Miles Minutes

Subjects/Grades You Are Comfortable Tutoring In

Please indicate the grade levels you are willing to tutor:

Elementary School

Area of Specialization:

Middle School

Area of Specialization:

Study Skills	Basic Math	Pre-Algebra Math
English	Writing	Social Studies
Science	Other

High School

Area of Specialization:

Test Prep

Area of Specialization:

Foreign Languages

Area of Specialization:

List other Languages:

Computers

Area of Specialization:

Basic Home Computing: Internet, E-mail, MS Word, MS Excel, Etc.
Basic Networking	Adv. Networking	Other
Quicken/Quick Books

Special Education

Area of Specialization:

Do you have significant experience with Learning Disabled? Yes No
Please mark all that apply if "Yes" was selected above:
ADD	ADHD	Dyslexia
Autism	Other

List if "Other" checked above:

Other Skills and/or Training

Do you have any special skills or training that will aid in the development of our students? If yes, please explain below:

Availability/Schedule

School Year Availability (September - June)

Please indicate the days of of the week you desire to work as a tutor:

Saturday

Sunday

Hours Availability (September - June)

Please indicate the number of hours per week you desire to work as a tutor:

Summer Availability (July - August)

Please indicate the days of the week you desire to work as a tutor:

Saturday

Sunday

Hours Availability (July - August)

Please indicate the number of hours per week you desire to work as a tutor:

References

Professional and Personal References

Professional References and Telephone Numbers:

Name:	nnn-nnn-nnnn
Name:	nnn-nnn-nnnn
Name:	nnn-nnn-nnnn

Personal References and Telephone Numbers:

Name:	nnn-nnn-nnnn
Name:	nnn-nnn-nnnn
Name:	nnn-nnn-nnnn

Official Background Information

Have you ever been convicted of a misdemeanor or felony? Yes No

If "Yes", where and for what felonies and/or misdemeanors?

Will you submit to a drug test? Yes No

Will you submit to a background check? Yes No

Please include your Resumé below:

I certify that the information I have provided above is true, accurate and correct:

Signature (Required) Date Format = mm/dd/yyyy

To print and mail an application directly to the address below - CLICK HERE

	Academic Coaches Tutoring
	2440 Sandy Plains Road
	Building #2, Suite 210
	Marietta GA 30066
	Atlanta Metro: (678) 324-0960 Toll Free: (1-877) 378-7170
	Academiccoach@comcast.net

Are you currently a certified teacher?	Yes No	Years teaching
Have you ever worked as a private tutor?	Yes No	Years tutoring
Have you ever worked for a tutoring company?	Yes No	Years Working
Willing to tutor at a student's home?	Yes No
Willing to tutor at other locations?	Yes No
Willing to tutor student groups?	Yes No

Pre K	K	1	2	3
4	5	6	7	8
9	10	11	12	Adult

Study Skills	Reading	Reading Comprehension
Spelling	Writing	Phonics
Grammar	Math	Other

Basic Math	Algebra 1	Algebra 2
Adv. Algebra	Geometry	Pre-Calculus
Calculus	Trigonometry	Physics
Chemistry	Biology	Anatomy
Government	US History	World History
Economics	English Comp.	Eng./Grammar/Spelling
Study Skills	Reading Comp.	Organizational Skills
Creative Writing

PSAT	SAT I - Math	SAT I Verbal
SAT II	ACT	MCAS
SSAT	GED	General Test Prep

Spanish I	Spanish II	Spanish III
Spanish IV	French I	French II
French III	French IV	Italian
Portuguese	German	ESL (as 2nd language)
Latin	Chinese	Other (See below)