You must have JavaScript enabled to use this form. Full Name NMU IN Date available to begin work: Cumulative GPA Date of Birth Are you on work study? Yes No Permanent Address Permanent Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Local/NMU Address Local Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone Email Anticipated Graduation Date (approximately) Major Minor (1) Minor (2) Teaching, tutoring, or other related experience List two school references (include an NMU faculty member who knows your skills in the area of expertise, if possible). Name/Title Contact Name/Title Contact How many hours per week would you like to tutor? List below the courses, in which you've earned a 'B' or higher, that you would be willing to tutor. Course Number and/or Title Sign and date below: This certifies that the information contained in this application is true to the best of your knowledge. Full Name Today's Date Student Employee Confidentiality Statement FERPA (Family Educational Rights and Privacy Act of 1974, also known as the Buckly Amendment) By signing below, I verify that FERPA (Family Educational Rights and Privacy Act of 1974, also known as the Buckly Amendment) information has been given to me, and has been read and understood by me. I further agree to observe the confidentiality of all student information to which I am exposed in the course of my employment, including student grades, records, test results, or any verbal communication concerning another student. I agree to keep confidential any disclosure of learning or other disabilities of any students with whom I work. I understand that a violation of confidentiality is grounds for immediate termination of my employment. Student Employee Name Today's Date Leave this field blank
