English tutor application form
Salutation:
Mr.
Ms.
Mrs.
Dr.
Last name:
First name:
Phone number:
Campus ext.:
UW email address:
Language(s) spoken:
Language(s) written:
Faculty:
Department:
UW ID number:
Age:
Status:
Undergraduate:
1st Year
2nd Year
3rd Year
4th Year
Graduate:
Masters
Ph.D.
Other:
Non-Degree
Alumni
Other
Which are you willing to help with?
Conversation
Written
Available to tutor for:
Spring
200
6
Fall
200
6
Winter
200
6
Comments:
Declaration:
I hereby declare that the above information is true and complete to the
best of my knowledge. I understand that a false statement may disqualify me
from further consideration as a volunteer or result in dismissal.
Authorization for collection of personal information
I authorize the International Student Office to collect personal
information appropriate to the position applied for concerning my academic
background and employment/volunteering history, and to verify the character
references I have supplied.
I understand that the information obtained will be confidential but will be
shared with persons I will be tutoring.
Form of Consent:
The information you provide will be used to deliver services. In addition,
name, address, and email information will be used to keep you up to date on
the activities of the International Student Office, services, special
events, and opportunities through periodic notices. If you do not want to
receive these notices, please contact us at 519-888-4567 x5995 or
mailto:darlene@uwaterloo.ca
.
I agree to this declaration and comply with its terms.