NORTH Service Learning Academic Tutoring Application  2021-2022
Please fill out EACH section of this form. After completing this form, you will be be directed to a Service Learning Academic Tutoring Applicant Questionnaire.
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Applications will be reviewed from juniors and seniors who are NOT NME (needs medical excuse) attendance status.
First and last name *
Gender
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Date of birth *
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Grade NEXT school year *
Personal Cell phone number *
Parent or guardian Name and phone number *
Address *
Email *
Please verify the number of days absent with attendance. Remember, you can not be on NME. These will be checked. *
Students must agree to follow the PHSN/PHSC Code of conduct.  Any discipline relating to the drug, tobacco, and alcohol school policy will result in dismissal and loss of credit from this program.  I agree to follow the PHSN/PHSC School Code of Conduct and am aware that discipline relating to the drug, tobacco, and alcohol school policy will result in dismissal and loss of credit from this program.  Please type your name below stating you understand the rules and guidelines. *
Students will be responsible for prompt, regular attendance at the placement.  After two missed days, students will be required to make-up missed service time.  Please type your name below stating you understand the rules and guidelines. *
Do you have a valid driver's license? *
Please list the make of your car and license plate. If you do not have a car, please list when you will have transportation.
Students will be responsible for their own transportation to the placement.  Students must have a current driver’s license and have reliable transportation. Please type your name below stating you understand the rules and guidelines. *
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