Professional Documents
Culture Documents
Cell Phone:________________________
Employer Information:______________________________________________________
Employer Address:________________________________________________________________
Street
City
Zip
Supervisor Name:_________________________________________________________
Supervisor Phone:_________________________________________________________
Parents Income (pre-tax; please attach 2011 tax return or final 2011
paystub):____________
Student Information
Students Name:__________________________________________________________
Date of Birth:____________________ Grade Level: ____________________________
School Attending:_________________________________________________________
iLEAP scores (3rd and/or 5th)_________________________________________________
Subject(s) needed (check all that apply):
(
(
(
(
(
) GED
) Math
) English
) Reading
) Writing
(
(
(
(
(
) Science
) ACT
) SAT
) LEAP Boot Camp
) GEE Boot Camp
COMPLETE THE CHART BELOW. CHECK ONLY THE TIMES YOU ARE
AVAILABLE FOR TUTORING.
TIME
9-10
am
1011am
1112pm
12-1
pm
1-2 pm
2-3 pm
3-4 pm
4-5pm
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
5-6 pm
6-7pm
7-8 pm
8-9 pm
) iLEAP scores
) GEE scores
________________________________
Parent or Guardian Signature
_____________
Date