Application
for Tutoring
APPLICATION
FOR APPROVAL OF TUTORING
(To be completed by Tutor)
Student_________________________
School________________ Date__________
Address____________________________________________
Telephone________
____________________________________________
Grade in School (Circle) 9 10 11 12
Course______________________________________________
This
is a _____Make-up Course _____Course for New Credit
Department_____________________________________________
Name
of Tutor_________________________________ Telephone______________
Address______________________________________
_______________________________________
Attach
a copy of NJ Teaching Certificate of Tutors who are not employees of
the District.
Approved
_______________________________ Disapproved__________________
Hours
of tutorial instruction for this course _________________
Comments:
_________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________________________________
Guidance
Counselor Date
_______________________________________________
Supervisor
of Dept. Involved Date
______________________________________
Principal
Date
Revised
9/86
Certification
of Tutoring
CERTIFICATION
OF TUTORING
Student______________________________________
Course______________________________________
I
certify that I tutored the above-named student for a total of ____________
hours on
the dates listed below:
Date
# Hours
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
______________________________
Signature
of Tutor Date
At
the completion of tutoring, the tutor must submit all written work
completed by the student
to the subject supervisor.
Grade
Approved______ Credits_______
Approvals:
______________________________________
Signature of Dept. Supervisor Involved Date
______________________________________
Signature of Principal Date
______________________________________
Signature of Counselor
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