Interview Date                                          Date Applied                                

In order to tutor, you must have attended WSU for at least 12 hrs, be registered for at least 6.0 undergraduate hours (12 hrs for international students) or 4.5 graduate hours and have a cumulative GPA of at least 2.8.

NAME:                                                                     UID:                                                 

              (LAST)                 (FIRST)             (MI)

LOCAL ADDRESS:                                                                                          

                              (STREET, CITY,  ZIP CODE)

PHONE: (Home)                                             (Work)                                                    

YEAR:  (Circle one)   FR    SO    JR   SR    GR     MAJOR                                                         

BIRTHDATE                            E-MAIL ADDRESS                                                            

Are you employed elsewhere on campus?                       If yes, where?                                

Can I give your name off campus for private tutoring opportunities?    Y             N      

Are you interested in Supplemental Instruction (SI)?      Y             N        

How many hours per week would you be available?                   

By submitting this application, I am giving permission for Wright State Tutoring Services to obtain a copy of my transcript.

                                                                                                                                                                                         (Signature)                                                                                                     (Date)

Date Interviewed                                                         By                                                                           

Hired:     Y             N       

List the courses you are qualified to tutor in order of preference. Include number and abbreviation. Courses not taken at WSU require WSU faculty approval unless you tested in at a higher level course. For example, if you tested into MTH 229 you can tutor any math course below 229. All language courses require approval from the Modern Language Dept.

COURSE ABBREV./NUMBER         GRADE REC"D     FACULTY APPROVAL