Caltech Y Rise Program
Tutor Application Form.  Before completing the form please make sure that you can commit to tutor for at least 2 terms and that you will be able to attend regularly and on time.  
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 I. TUTOR  CONTACT INFORMATION
Last Name *
First Name *
E-mail Address? *
Cell Phone *
Local Address *
City, State, and Zip *
Year *
Department/Major *
Work Study Amount
If applicable
 II. SCHEDULE INFORMATION
 Please indicate your availability for the current term. *
Select all days that apply
Required
 Please indicate your preferred day of tutoring. *
Select all days that apply
Required
Do you have any possible conflicts with the days indicated.
If so, what?
How many days per week would you like to tutor? *
Required
Would you like to serve as a sub when extra tutors are needed? *
If your tutee is suddenly going to be absent how would you like to be contacted? *
Required
 III. TEACHING PREFERENCES
Do you have a preferred age range of students that you would work with?
 I would love to teach these subjects: *
Check all that apply
Required
 I can teach these subjects if necessary: *
Check all that apply
Required
Contact: Liz Jackman
The Caltech Y
Phone: 626.395.6163
Email: ljackman@caltech.edu 
Website: www.caltechy.org
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