APPLICATION FORM

This application is designed to collect specific information from applicants applying for the Tutoring Assistance Program and will be kept strictly confidential.

In addition to completing this form, you will need to provide the following in order to be considered for tutoring assistance:

A copy of the student’s most recent report card
A completed Teachers’ Referral Form

Teachers' Referral Form

A. Application Information

* Indicates required field

Student's Name: *

School attended: *

Name of Parent/Guardian: *

Address: *

Postal Code: *

Student’s Date of Birth: *

Grade: *

Email: *

City: *

Phone (home): *

Phone (other): *

B. Other Information

Please provide any additional information regarding your household situation (# of dependents, employment status, etc.) that will help us understand your need and eligibility for assistance. *

C. Declaration of Low Income

TAS is directed to low-income families. Please confirm that is your situation by initialing the following declarations.

I declare that our financial situation is considered "low income". Please initial here. *

I declare that all information provided to TAS is true and complete. Please initial here. *

I understand that the parent (or guardian) is responsible for the child's well-being and safety while the tutor is present. Please initial here. *

Submit Your Application

If you prefer you can download the Application Package, fill it out and send it to us.

2018-2019 Application Package