CAL-SOAP TUTOR INFORMATION SHEET
PERSONAL INFORMATION:
Name:
________________________________________
Expected Graduation Date: ____________________________
Address: ________________________________________
City, State, Zip: ____________________________
Phone:
E-mail:
_______________________________________
____________________________________
EMERGENCY CONTACT INFORMATION:
Emergency Contact Name: __________________________
Relationship: _______________________________
Phone:
Alternate Phone: ____________________________
_______________________________________
EDUCATIONAL/TUTORING INFORMATION:
Currently enrolled at (circle one):
Bilingual Fluency:
Y
Preferred level of Tutoring (circle one):
SBCC
UCSB
N
Westmont
Other: ___________
Language(s): ___________________________
Junior High/Middle School
High School
Either
I understand I will be placed at a Cal-SOAP site in Goleta, Santa Barbara, or Carpinteria based on need not preference.
Initial ____________
Please rank from 1 - 4 (4 being highest) which subject(s) you feel most proficient to tutor:
Math: _____
Sciences: ______
Reading: ______
English: ______
Cross out (X) the blocks of time you are UNAVAILABLE
Monday
Tuesday
Wednesday
Thursday
Friday
8:00 – 8:30a
8:30 – 9:00a
9:00 – 9:30a
9:30 – 10:00a
10:00 – 10:30a
10:30 – 11:00a
11:00 – 11:30a
11:30 – 12noon
12 – 12:30p
12:30 – 1:00p
1:00 – 1:30p
1:30 – 2:00p
2:00 – 2:30p
2:30 – 3:00p
3:00 – 3:30p
3:30 – 4:00p
4:00 – 4:30p
4:30 – 5:00p
5:00 – 5:30p
5:30 – 6:00p
6:00 – 6:30p
6:30 – 7:00p
After 7:00p
I am committed to work no more than ___________ hours per week (cannot exceed 20 hours)
________________________________________
Signature
_________________
Date
Initials: _______ Date: _________
NOTES: _______________________________________________________________________________________________
Cal-SOAP Office Use Only
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