Please print out this form and bring it to TASC in person.

APPLICANTS MUST HAVE EARNED A GRADE OF 'B' OR BETTER IN THE COURSE(S) IN WHICH HE/SHE WILL BE TUTORING, AND/OR HAVE SIGNED RECOMMENDATION(S) OF FACULTY MEMBER(S).

Date: ______________________

Last Name: ____________________ First Name: _________________ MI: _______

Street Address: ______________________________________________________

City: _______________________________State:_______________ ZIP: _________

Student ID No: ___________________ Telephone: __________________________

e-mail:_______________________________________________________________

Emergency Contact: ____________________________Telephone:_____________

Program(s) of Study/Major(s):_____________________________

Work Experience

Hours Available To Work

Tell Us a Little Something About Yourself

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Applicant’s Signature: ______________________________________________

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e-mail: TASC@trcc.commnet.edu

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