ࡱ> O $bjbjrKrK 4!e!eN 8S<K.jS+++sm!q"-------$0k3b-"ss""-++H.W(W(W("++-W("-W(W(:,,,+Ϫ#vJ, -.0K.T,R3$3,3,""W("""""--&`"""K.""""3""""""""" : Student Success Center Peer Tutor Application Please complete & submit application to Dava Dudley in the Clarke M. Williams Student Success Center via email to dudley@ulm.edu. Complete application includes the faculty Recommendation Form on page 5. The application will not be accepted unless all 5 parts are completed. The Recommendation Form needs to be emailed directly from your reference to dudley@ulm.edu or returned in a separate sealed envelope to the Student Success Center. Application Requirements: Must have earned a B grade or better in the course(s) you wish to tutor. Must have attended full time for at least one semester. Must have taken the coursework you wish to tutor at the university in the U.S.A., preferably . Must be enrolled in at least 6 credit hours. Must be a mature, responsible individual dedicated to helping others achieve academic success. Must possess strong communication skills. Application is for (Semester/Year): _____________________ Date: _________________ Part One Applicant Name First NameMiddle Name/InitialLast NamePreferred NameCWID Local Contact Information StreetCity, State, ZipHome phoneCell phoneEmail Permanent Address StreetCity, State, Zip Education MajorClassification Hours EarnedCumulative GPA Sem.&Year of Grad. Have you tutored before?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, when & where? ____________________________________________________________ Part Two Check the courses that you are interested in tutoring and note that we tutor only math and sciences. The more classes you are interested in and able to tutor, the better. Check as many courses as possible that you have taken here at and passed with a grade of an A or B.  FORMCHECKBOX MATH 0093 (Developmental Math)  FORMCHECKBOX BIOL 1001 (The Living World)  FORMCHECKBOX MATH 1009 (Applied Algebra)  FORMCHECKBOX BIOL 1014 (intro A&P I)  FORMCHECKBOX MATH 1011 (College Algebra)  FORMCHECKBOX BIOL 1015 (intro A&P II)  FORMCHECKBOX MATH 1012 (Trigonometry)  FORMCHECKBOX BIOL 1020 (Principles I)  FORMCHECKBOX MATH 1013 (Pre-Calculus)  FORMCHECKBOX BIOL 2014 (Intro Micro)  FORMCHECKBOX MATH 1014 (Applied Calculus)  FORMCHECKBOX BIOL 2020 (Cell Biology)  FORMCHECKBOX MATH 1016 (Elementary Statistics)  FORMCHECKBOX BIOL 2026 (A&P)  FORMCHECKBOX MATH 1018 (The Nature of Math)  FORMCHECKBOX BIOL 2028 (Pathophysiology)  FORMCHECKBOX MATH 1031 (Calculus I)  FORMCHECKBOX BIOL 2040 (Anatomy)  FORMCHECKBOX MATH 1032 (Calculus II)  FORMCHECKBOX BIOL 3005 (Genetics)  FORMCHECKBOX BIOL 3010 (Physiology)  FORMCHECKBOX PHYS 2003 (General I)  FORMCHECKBOX PHYS 2004 (General II)  FORMCHECKBOX CHEM 1001 (Intro I)  FORMCHECKBOX PHYS 2007 (Mechanics,Sound,Heat)  FORMCHECKBOX CHEM 1002 (Intro II)  FORMCHECKBOX PHYS 2008 (Electricity,Magnetism,Light)  FORMCHECKBOX CHEM 1007 (General I)  FORMCHECKBOX CHEM 1008 (General II)  FORMCHECKBOX Other Math/Science_____________________  FORMCHECKBOX CHEM 2030 (Organic I)  FORMCHECKBOX CHEM 2032 (Organic II)  FORMCHECKBOX CHEM 3050 (Biocehmistry) Please list all relevant coursework. Course NameCourse #Grade ReceivedProfessorWhere TakenWhen Taken Part Three How many hours per week would you like to work? _______ List the times you are available to tutor. If you are unsure of the available work hours, leave it blank. Be aware that the SSC tutoring hours are Mondays-Thursdays 10:00 a.m. to 9:00 p.m. MONDAYTUESDAYWEDNESDAYTHURSDAYTIMES YOU ARE AVAILABLE Part Four Please briefly respond to the following 5 questions (PRINT CLEARLY): How would you describe the role of a tutor? Have you participated in other experiences that are relevant to the responsibilities of this position? What is your definition of academic success? What advice would you give to another student on how they can be more successful in the classroom? The SSC Tutoring Centers primary goal is to foster independent learning. What do you think this goal means? How would you foster the independent learning of your students? Part Five Please list the contact information for 3 faculty references, who know the quality of your work.*** Please have in mind that since we offer tutoring in math and sciences, it is necessary to submit references from at least 2 math and/or science faculty members. NameTitle PhoneEmail NameTitle PhoneEmail NameTitle PhoneEmail***Please ask one of these three faculty references to fill out the Recommendation Form on page 5. Recommendation Form should be completed by math/science faculty. Thank you for your application! Youll be contacted to schedule an interview if your application meets the criteria and we have positions available. Submit application to Dava Dudley at dudley@ulm.edu. Your application will not be considered unless the Recommendation Form is emailed directly from your reference to  HYPERLINK "mailto:dudley@ulm.edu" dudley@ulm.edu or returned in a separate sealed envelope to the Student Success Center. If you have any questions, please contact Dava Dudley at dudley@ulm.edu Student Success Center Peer Tutor Faculty Recommendation Form Note to Faculty: Please email the completed form directly to  HYPERLINK "mailto:dudley@ulm.edu" dudley@ulm.edu or return the form to the applicant in a sealed envelope with your signature across the seal. Thank You! ____________________________________________________ __________________________ Name of Tutor Applicant Subject ____________________________________________________ __________________________ Name of Recommender Position How long have you known the applicant? ___________________________________________________ In what capacity have you known the applicant? ______________________________________________ Please rate the applicant in the following areas. Base your ranking in comparison to other students. UnknownBelow AverageAverageAbove AverageSuperiorSubject Knowledge- Grasps subject matter. Communication- Articulates the concepts necessary to explain the subject and effectively express his/her ideas.Professionalism- Demonstrates responsibility and dependability. Is diligent and self-motivated. Interpersonal skills-Displays ability to relate to other students, builds rapport, and expresses cultural sensitivity. Please elaborate on the applicants strengths or potential weaknesses as they relate to tutoring. Additional Comments: Do you recommend this student to be a tutor?  FORMCHECKBOX Yes  FORMCHECKBOX  No Signature: ____________________________ Date: _____________ If you have any questions or comments, please contact Dava Dudley or call 342-3667.     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