TLC Student Application
If you want to be a student with Troy Literacy Council, please complete this form. All of your personal identifying information will remain confidential within our organization. If you have questions, please call us at (937) 660-3170 or email us at troyliteracy@gmail.com. If you need help to answer these questions, please call and we will be glad to help you.
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Today's Date: *
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First Name: *
Last Name: *
Address: *
Birthdate: *
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Gender: *
Home Phone:   [ example format:  (123) 456-7890 ]
Cell Phone: [ example format: (123) 456-7890 ]
Email address: *
Best way to contact you? *
Ethnicity/Race (select one) *
Employment (select one) *
What days/times do you prefer to tutor? Please select at least one. *
Morning (8:00am-12:00pm)
Afternoon (12:00-5:00pm)
Evening (5:00-8:00pm)
Sunday
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