Volunteer Tutoring Program at the Clayton Community Library |
6125 Clayton Road, Clayton, CA 94517(925) 673-0659 |
REQUEST FOR
TUTORING OR HOMEWORK HELP |
| Student's Name:_____________________________________________Date____________ |
| Grade:__________ Age:_____ School: __________________________________________ |
| Parent/Guardian Name:_______________________________________________________ |
| Home Phone: ______________ Work Phone: ______________E-mail:__________________ |
| NEEDS HELP WITH THE FOLLOWING SUBJECT(S): (Check) |
Reading _______ Math _________ History________ |
Writing ________ Science _______ Other _________ |
| SCHOOL TEXT BOOK(S) USED:________________________________________________ |
| __________________________________________________________________________ |
| IDEAS FOR AIDING STUDENT: (Special interests, working style, issues or concerns):________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| PREFERRED SESSION TIMES: |
| Day(s) of Week: __________________________________ Hours:______________________ |
| TEACHER NAME: ___________________________________________________________ |
| Phone: ________________ __________E-mail:____________________________________ |
| Please Note: We will make every effort to assign a tutor/homework helper as soon as possible. In the meantime, join our group tutoring sessions on Wednesday afternoons. When a tutor is available he or she will contact you. A schedule of sessions will then be arranged at a mutually agreeable time. All tutoring is provided by volunteers during library hours in the Clayton Community Library. Transportation must be provided by the student. If you provide your child's teacher's name, the tutor may contact the teacher. The tutor will periodically evaluate the student's progress to determine the need for continuing the sessions. |
| I understand and agree with the above: (parent's signature)__________________________ |
| ___________________________________________________________________________________________________________________ |
| FOR ADMINISTRATIVE PURPOSES ONLY: |
| Initial contact (date): __________Type of Tutor preferred:______________________________ |
| Assigned Tutor: _________________________________________ Phone: _____________ |