Name (Last, First)

Date

WSU ID

Please provide only last 4 digits for privacy:

Address

City

State

Zip

Phone Number (incl. area code)

Best time to call:

E-Mail Address

Your major:

Cumulative GPA:

Completed semester credits:

Expected graduation date:

Are you a US Citizen or Permanent Resident?

Yes No

If no, your current visa type:

Are you applying to be (check all that apply):

An Individual Tutor
A Tutor in the Quantitative Skills Center - Math Lab

Please indicate courses that you can tutor:

Course you can tutor:	Grade you earned:	Professor:	Where course was taken:	Have you tutored in this subject before?
				Yes No
				Yes No
				Yes No

List any tutoring or related experience that you believe would strengthen your application to become a tutor: (i.e. volunteer work, assisting students and/or teachers)

Please provide 2 names of faculty members or instructors including at least one faculty/instructor in the subject area you would like to tutor:

Name:	College/ University:	Course taken:	Phone #:	Email:

Upon receipt, SRC will email you Tutor Recommendation Forms; please give Tutor Recommendation Form to each person from whom you seek a reference. Interviews and 2-hour mandatory training will be scheduled throughout each semester; you will be contacted for more information.