Fall

Spring

Both Semesters

Subject areas you wish to tutor (e.g. French, history, etc.): *

Personal Information

Student ID:	*
First Name:	*
Last Name:	*
M.I.:

	Yes	No
Have you ever applied to Financial Aid for a Work Study Award?
Have you received Financial Aid for Work Study?

How many hours each week are you available?
School or College in which you are enrolled:

Major(s):
Minor(s):
Status:	Freshman Sophomore Junior Senior Graduate Special
Current GPA:

Contact Information

Street:	*
City:	*
State:	*
Zip:	*

Email:	*
Home Phone:	- *
Times to Call:
Work Phone:	-
Times to Call:

Educational Background

School	From	To	Degree

Courses

Please refer to the list of courses tutored in the program. These courses may be subject to change each semester. You must have taken the course or its equivalent and have earned an A or B in order to tutor it. Exceptions are Reading, Study Skills ESL, lower Math courses (090, 095, 105), English composition, and very similar courses such as Chemistry 102/117 and 104/118. Please indicate which of these courses you are qualified to tutor and those you prefer to tutor. Please enter the department and course number in the course no. field and then a brief description in the title field. For example, Psych 101, Introductory to Psychology. Then indicate your grade to the right of each course you are able to tutor.

can tutor	prefer to tutor	Course No.	Title	UWM grade	Other grade
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B

Other Courses

Please indicate any other courses you are willing to tutor that are not in the list of courses tutored by the department.

can tutor	prefer to tutor	Course No.	Title	UWM grade	Other grade
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B
				A A- B+ B	A A- B+ B

Work Experience (List most recent first)

Most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

Next most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

Next most recent position:

Postion	From	To
Agency or Firm	Supervisor
Address
Duties

References

Give at least three (3) references, such as professors or past employers, related to the subject(s) to be tutored or your working ability. We recommend that you have two letters of reference sent to us: Panther Academic Support Services, PASS/Bolton 180, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201. If possible, one letter should be from a professor in your preferred subject area.

Reference 1:

Name	Title
Address
- Phone Number

Reference 2:

Name	Title
Address
- Phone Number

Reference 3:

Name	Title
Address
- Phone Number

Additional Comments

I hereby certify that the above is true, that this department may contact any of the above listed references, and that a UWM transcript may be released to the Department.

Input your name here if you agree to the above statement: