Literacy Tutor Registration
About You
First Name
Last Name
Birthdate
MM/DD/YYYY
Gender
Female
Male
Non-Binary
Ethnic Origin
Please select...
White
Black
Hispanic/Latino
American Indian/Alaska Native
Asian
Hawaiian/Pacific Islander
Other
2 or More Races
Have you graduated High School?
Yes
No
Preferred Location
Please select...
Springfield
Hillsboro
Litchfield
Beardstown
Jacksonville
Taylorville
Contact Information
Street Address
City
State
Please select...
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Zipcode
Primary Phone Number
Usually your cell phone if you have one
Secondary Phone Number
Another number we can reach you at (work, home, etc)
Email Address
Email Confirmation
Email Match Check
Email Match Error
Emergency Contact
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship
Special Medical Conditions
Tutoring
Have you been a tutor with us previously?
Yes
No
Tutor Focus Areas
English Language Learner
Reading/Writing
Math
Other
Other Focus:
Please list any Volunteer / Teaching Experience
Years of Tutoring Experience
Availability
Monday mornings
Monday afternoons
Monday evenings
Tuesday mornings
Tuesday afternoons
Tuesday evenings
Wednesday mornings
Wednesday afternoons
Wednesday evenings
Thursday mornings
Thursday afternoons
Thursday evenings
Friday mornings
Friday afternoons
Friday evenings
Saturday mornings
Saturday afternoons
Saturday evenings
Sunday mornings
Sunday afternoons
Sunday evenings
How did you learn about this program?
Please select...
LLCC website
Newspaper
Social Media
Friend or Relative
Other
Other (learn about us):