Tutor Application

Alternate Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you find out about UPLIFT? (church, friend, website, United Way, etc) *

Why are you interested in being a Kids at Heart tutor? *

What age groups and subjects are you most comfortable with? *

Community Involvement *

Church Affiliation *

Universities/Colleges attended and degrees earned *

Personal Reference Name *

First

Last

Personal Reference Email *

Personal Reference Phone Number *

Professional Reference Name *

First

Last

Professional Reference Email *

Professional Reference Phone Number *

Have you ever been accused of a crime? *

Yes No

If Yes, why and when? *

Have you ever been convicted of a crime? *

Yes No

If Yes, why and when? *

Do you promise not to smoke, drink alcohol, partake in drugs, or break the law while working with Kids at Heart? *

Yes No

As a KAH Tutor, I will be supportive, provide guidance, and serve as a positive role model for my Kids at Heart student. *

Yes No

Please choose your top three tutoring sites (we will do our best to accomodate) *

Mondays 3:00-4:15pm at First Presbyterian Church 320 Date Street, San Diego, CA 92101 Mondays 4:30-5:45pm at Iglesia Presbiteriana 2691 B Street, San Diego, CA 92102 Mondays 5:45-7:00pm at St. Paul's Cathedral 2728 6th Avenue, San Diego, CA 92103 Tuesdays 2:45-4:15pm at Italian Cultural Center 1669 Columbia Street, San Diego, CA 92101 Tuesdays 5:00-6:00pm at Hacienda Learning Center 350 17th Street, San Diego, CA 92101 Tuesdays 6:15-7:30pm at Inner City Christian Fellowship 4092 Newton Avenue, San Diego, CA 92113 Wednesdays 5:30-6:30pm at One America Plaza 300 W Broadway, San Diego, CA 92101 Wednesdays 6:00-7:30pm at Iglesia Presbiteriana 2691 B Street, San Diego, CA 92102 Thursdays 3:30-5:00pm at Orange Avenue/Urban Life Church 5202 Orange Avenue, San Diego, CA 92105

I understand that once the Program Manager receives this Tutor Applicaiton, I will be contacted to schedule a meeting/orientation (to go over the program in more detail, answer any questions you may have, and decide on a tutoring site that works best) as well as receive information about where to get fingerprinted *

Yes No

Tutor Application - UPLIFT/Kids at Heart tutoring