2012-2013 America Counts Application

Last Name *

First name *

ONYEN *

Alternate email address

Over the summer, we will primarily communicate via your UNC email address; if you would prefer that we use an alternate email address, please provide it here.

Phone number *

Please provide us with a number where we can reach you in case of urgent matters.

Emergency contact name *

Please provide the name of the person whom we should contact in case of an emergency.

Emergency contact relationship *

(Parent, sibling, partner, guardian, grandparent, spouse, friend etc.)

Emergency contact phone number *

Please provide the phone number of the person whom we should contact in case of an emergency.

Emergency contact email address *

Please provide the email address of the person whom we should contact in case of an emergency.

Classification *

(If you are a junior transfer, please select "Junior")

First Year

Sophomore

Junior

Senior

How many years have you worked for America Counts? *

None-- 2012-2013 would be my first year

One-- 2012-2013 would be my second year

Two--2012-2013 would be my third year

Three-- 2012-2013 would be my fourth year

Other:

Will you be enrolled full-time at UNC for both the fall 2012 and spring 2013 semesters? *

Yes

No-- I'm graduating in December

No-- I will spend at least one semester abroad

No-- I have an off-campus internship

I'm not sure

Other:

Are you eligible for federal work-study?

(All America Counts positions are work-study positions)

Yes

No

I don't know

Clear selection

Scheduling *

Regular and punctual attendance at your tutoring site at training sessions, and at reflection meetings is required. Therefore, you will be assigned tutoring and meeting times that fit your schedule. Do you understand that your tutoring and reflection meeting schedule must be maintained even when you have exams or papers due?

Yes

No

Scheduling- Monday

Keeping in mind your class schedule and extracurricular commitments, as well as a maximum of 30 minutes of travel time, please indicate all the times you are available to tutor or meet for reflection sessions.

Monday

8am-8:30am

8:30am-9:00am

9:00am-9:30am

9:30am-10:00am

10:00am-10:30am

10:30am-11:00am

11:00am-11:30am

11:30am-12:00pm

12:00pm-12:30pm

12:30pm-1:00pm

1:00pm-1:30pm

1:30pm-2:00pm

2:00pm-2:30pm

2:30pm-3:00pm

3:00pm-3:30pm

3:30pm-4:00pm

4:00pm-4:30pm

4:30pm-5:00pm

5:00pm-5:30pm

5:30pm-6:00pm

6:00pm-6:30pm

6:30pm-7:00pm

7:00pm-7:30pm

7:30pm-8:00pm

Clear selection

Scheduling- Tuesday

Keeping in mind your class schedule and extracurricular commitments, as well as a maximum of 30 minutes of travel time, please indicate all the times you are available to tutor or meet for reflection sessions.

Tuesday

8am-8:30am

8:30am-9:00am

9:00am-9:30am

9:30am-10:00am

10:00am-10:30am

10:30am-11:00am

11:00am-11:30am

11:30am-12:00pm

12:00pm-12:30pm

12:30pm-1:00pm

1:00pm-1:30pm

1:30pm-2:00pm

2:00pm-2:30pm

2:30pm-3:00pm

3:00pm-3:30pm

3:30pm-4:00pm

4:00pm-4:30pm

4:30pm-5:00pm

5:00pm-5:30pm

5:30pm-6:00pm

6:00pm-6:30pm

6:30pm-7:00pm

7:00pm-7:30pm

7:30pm-8:00pm

Clear selection

Scheduling- Wednesday

Keeping in mind your class schedule and extracurricular commitments, as well as a maximum of 30 minutes of travel time, please indicate all the times you are available to tutor or meet for reflection sessions.

Wednesday

8am-8:30am

8:30am-9:00am

9:00am-9:30am

9:30am-10:00am

10:00am-10:30am

10:30am-11:00am

11:00am-11:30am

11:30am-12:00pm

12:00pm-12:30pm

12:30pm-1:00pm

1:00pm-1:30pm

1:30pm-2:00pm

2:00pm-2:30pm

2:30pm-3:00pm

3:00pm-3:30pm

3:30pm-4:00pm

4:00pm-4:30pm

4:30pm-5:00pm

5:00pm-5:30pm

5:30pm-6:00pm

6:00pm-6:30pm

6:30pm-7:00pm

7:00pm-7:30pm

7:30pm-8:00pm

Clear selection

Scheduling- Thursday

Keeping in mind your class schedule and extracurricular commitments, as well as a maximum of 30 minutes of travel time, please indicate all the times you are available to tutor or meet for reflection sessions.

Thursday

8am-8:30am

8:30am-9:00am

9:00am-9:30am

9:30am-10:00am

10:00am-10:30am

10:30am-11:00am

11:00am-11:30am

11:30am-12:00pm

12:00pm-12:30pm

12:30pm-1:00pm

1:00pm-1:30pm

1:30pm-2:00pm

2:00pm-2:30pm

2:30pm-3:00pm

3:00pm-3:30pm

3:30pm-4:00pm

4:00pm-4:30pm

4:30pm-5:00pm

5:00pm-5:30pm

5:30pm-6:00pm

6:00pm-6:30pm

6:30pm-7:00pm

7:00pm-7:30pm

7:30pm-8:00pm

Clear selection

Scheduling- Friday

Keeping in mind your class schedule and extracurricular commitments, as well as a maximum of 30 minutes of travel time, please indicate all the times you are available to tutor or meet for reflection sessions.

Friday

8am-8:30am

8:30am-9:00am

9:00am-9:30am

9:30am-10:00am

10:00am-10:30am

10:30am-11:00am

11:00am-11:30am

11:30am-12:00pm

12:00pm-12:30pm

12:30pm-1:00pm

1:00pm-1:30pm

1:30pm-2:00pm

2:00pm-2:30pm

2:30pm-3:00pm

3:00pm-3:30pm

3:30pm-4:00pm

4:00pm-4:30pm

4:30pm-5:00pm

5:00pm-5:30pm

5:30pm-6:00pm

6:00pm-6:30pm

6:30pm-7:00pm

7:00pm-7:30pm

7:30pm-8:00pm

Clear selection

Please indicate that you understand that chronic lateness and absences are grounds for dismissal. *

Working with children requires reliability and dedication above and beyond that required by many other jobs. Any absence will be brought to the attention of the program director and dealt with on a case-by-case basis.

Yes

No

Keeping in mind that you have many responsibilities as a college student, based on a scale of one to ten, what level of commitment will you be able to pledge to America Counts if hired? *

Little or no commitment

1

2

3

4

5

6

7

8

9

10

100% commitment

Please explain your previous answer regarding level of commitment to the program. *

Transportation *

Please indicate via the checkboxes whether you have a car, whether you are willing to drive other tutors to your site, and whether you are willing to take the Chapel Hill bus to your site.

I do not have a car.

I have a car.

I am willing to take the Chapel Hill bus to my site.

I am willing to drive others who have the same schedule to my site. (If yes, please type in the "Other" box the number of passengers you can take.)

I have a current, valid driver's license. (You may be asked to present your license to the program director before being authorized to drive.)

Other:

Required

America Counts tutors are required to have either placed out of or earned a B or higher in at least one first year UNC-CH mathematics course. *

Please list which courses you placed out of and/or the grade earned in any UNC-CH math classes that meet this qualification.

Please describe your previous tutoring experience. *

(You may describe any tutoring experience, regardless of subject, but we are particularly interested in knowing about your math tutoring experience.)

What is your interest in tutoring math? *

What else would you like me to know about you?

Please read the following policies and procedures of Chapel Hill-Carrboro City Schools (CHCCS) and Orange County Schools (OCS), and then proceed to the next questions.

*CHCCS/OCS are smoke-, alcohol- and drug-free zones.

*No one other than staff may take a student off campus without written permission from parents and principal.

*Unless otherwise authorized, all tutors must remain within sight of a school staff member.

*No one other than an approved school staff member may administer medicines.

*Students, staff and tutors should refer any injury or accident to the classroom teacher or after-school coordinator, who will follow the proper procedures.

*Information received as the result of the individual's activities in the school is to be kept strictly confidential.

Indicate by checking the boxes if you:

(we will contact you to discuss anything checked)

have been convicted of a crime involving drugs, sex, or physical violence

have had charges of child abuse, neglect or domestic violence substantiated by Social Services

have a history of child molesting

currently use drugs or abuse alcohol

Please read the following pledge and check the appropriate box to indicate whether or not you agree to it. *

I agree to abide by the policies, procedures and regulations of the Chapel Hill-Carrboro City Schools and/or Orange County Schools. I certify that all information given above is true and accurate. If any of the information above changes, I agree to notify the America Reads & Counts program director.

I agree

I do not agree

SCALE offers many opportunities throughout the year for college students to participate in service projects and special events on a volunteer basis. These opportunities provide tutors with a richer experience and allow for development of professional skills and networking. *

Please check any and all opportunities that interest you. Please see our website (www.readwriteact.org) for more information about SCALE events.

Participating in service projects/events on campus

Participating in service projects/events in the community

Participating in service projects/events in the schools

Assisting SCALE staff with planning and/or coordinating SCALE projects and events

Assisting SCALE staff with publicizing SCALE projects and events

Participating in virtual conferences and training events

Other:

Required

Do you intend to apply for an AmeriCorps Minimum Time Position with SCALE? *

SCALE's NC LiteracyCorps has a limited number of positions available to dedicated tutors who wish to augment their work-study with supplemental training and service activities. They earn a $1,175 education award after completing 300 hours of qualifying service in addition to other program requirements. There is an additional application process to be considered for this position. More information can be found here: http://readwriteact.org/nclc

Yes

No

Not sure

Other: