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Student Application
You can apply for a one-on-one tutor only if you live or work in Wayne County.
First Name *
Last Name *
Street Address *
example: 123 Reading Road
City *
Zip Code *
Primary Phone Number *
Secondary Phone Number
Email Address *
Gender *
Required
Date of Birth *
Place of Birth *
Primary Language *
Highest Level of Education *
Did you attend school in the US? *
Required
Are you employed? *
Required
Availability (check all that apply) *
The more available you are, the sooner you will receive a tutor
Required
If you have a learning disability, please describe below:
Lived in the US since what year?
Describe any health concerns
Explain any crime convictions
Student Agreement
I agree to pay a registration fee of $25.00 to the Community Literacy Council, Inc. at the assessment meeting for a one-on-one tutor. I understand that all tutoring sponsored through the Community Literacy Council, Inc. must be held in a public location. I understand that my commitment to learning is for 1.5 hours per week for 6-12 months. Attendance or participation in Community Literacy Council activities constitutes consent to be photographed for use in print and /or electronic publicity for the Plymouth-Canton Community Literacy Council. I affirm by my signature below that all of the information stated above is true and accurate to the best of my knowledge.
Type name below to accept terms of agreement *
Referral Source
(How did you hear about the CLC?)
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