Empowering Independence for All Abilities

Get in Touch

Address: 736 Southeast Jackson Street, Roseburg, Oregon 97470, United States

Phone: 541-672-6336

Fax: 541-672-8606

Online Tutor Application

First Name:

Last Name:

Home Address:

City:

Zip Code:

Home phone number:

Email address:

Date available to start:

Preferred shift times for tutoring between 8am-4pm?

Preferred days for tutoring from Monday – Thursday?

Are you 18 years of age or older?

Under 18

Over 18

Do you have access to a reliable ride?

Yes

Describe any past tutoring or teaching experience.

Describe any relative special skills, interests, strengths.

List any languages you speak other than English.

Free Text

Current Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Previous Employer’s Name:

Supervisor’s Name and Phone Number:

What was your title?

What type of work did you do?

What dates did you work there?

Why did you leave?

Free Text

Emergency Contact Name and Phone Number:

Do you agree to fingerprinting and a background check?

Yes

Address

736 SE Jackson Street
Roseburg, OR 97470

Phone

541-672-6336

Fax

541-672-8606

Hours

Monday-Thursday: 8AM-4PM
Friday - Sunday: CLOSED

Closed for Lunch:
Monday-Thursday 12PM-1PM
Closed all major Holidays