*INDICATES THE FIELD MUST BE COMPLETED.
Personal Information * Current School Year:
*LAST *FIRST MIDDLE INIT.
*STREET ADDRESS
*CITY
*STATE *ZIP CODE
*STUDENT ID NUMBER *What is your race? *What is your gender? Male Female  
Parent/Guardian Information *LAST NAME
ADDRESS
PHONE NUMBER
Interests *What is your favorite subject in school?
*What is the easiest subject for you?
*Indicate how often you you do your homework?
*Have you ever reviewed chapters in your text without being told to do so?
*When you are doing your homework and having problems, do you have someone who can help you other than your teacher?
*How do you feel about going to college?
What college will you attend?
*Have you ever tutored a young child or an adult?
*Would you like to tutor an adult?
If no, why not?

*Are you planning to become a teacher?
*What grade level would you like to teach?
*What subject would you like to teach?
Would you like to be a school Administrator or Counselor?
*What is your current GPA?
*What grade are you currently in?
*What school do you attend?
              If you chose "Other", Please specifiy your school:
*Are you enrolled in OTC? Yes No