Page 1 of 2

Tutor Interest Form

Full name

Email address

Phone number

Age

What neighborhood are you from or most connected to?

Do you identify with the communities this program aims to serve?

A
B

Highest level of education completed

Current work/school status

Why do you want to become a community tutor?

What subjects would you feel comfortable learning to tutor?

Do you have any experience working with children?

A
B

Do you have any tutoring, mentoring, coaching, babysitting, camp, or youth program experience?

Are you available for paid training during the first month?

A
B

Are you available for tutoring/practicum during month two?

A
B

Can you commit to roughly 12 paid hours per week if selected?

A
B

What days/times are you usually available?

Are you comfortable traveling within Dorchester, Roxbury, Mattapan, and Hyde Park?

A
B

Are you willing to complete training on professional conduct, lesson planning, child safety boundaries, behavior support, and family communication?

A
B

Are you comfortable receiving coaching, feedback, and evaluation?

A
B

Optional: race or ethnicity

Optional: languages spoken

What strengths would you bring to this work?

What support would help you succeed as a tutor?