VOLUNTEER TUTORING PROGRAM

APPLICATION
Cheltenham Academics is a community-based volunteer program to help
strengthen the academic achievement of selected 8
th
and 9
th
graders. Trained
tutors are matched with students to help them with challenging class assignments
and boost vocabulary skills for successful academic achievement.


Name: ____________________________________________________ Date: _____________________
Address: ________________________________________________________________________________
Telephone (Mobile): __________________ (Home) ___________________
Email Address: ___________________________________________________________________________
Emergency Contact: _______________________________________________________________________
Degrees and Certificates Earned: _____________________________________________________________
Current Employer/University, or past employer if retired teacher:
________________________________________________________________________________________

Work Experience Summary:




Tutoring/Volunteer Experiences:




Describe any other training or experiences that may be pertinent to volunteering as a tutor:




Would you be willing to attend a 3-hour training workshop? Yes No

Please indicate your willingness to obtain the following clearance information:
PA Criminal Background Check; PA Child Abuse Clearance Yes No

Hours available for after-school tutoring:
Monday: ___ uesday: ______ day: __ hursday: _____

I am available for tutoring on the following dates:
Beginning Date: ____________ End Date: ___________

Possible tutoring skills (check as many as apply):
I have knowledge of content in math reading at the middle and early secondary levels
I have experience teaching or working with students who needed academic support:
Children Youth Adults

How do you think your background prepares you to be an academic tutor with Cheltenham Academics?





Signature: _____________________________________Date: ___________________