Counseling Program for Intercollegiate Athletes Tutor Application Form Name: Home Phone: Local Address: Office Phone: City, State, Zip:    Cell: Email: Peoplesoft ID: Academic Status:   --Choose one-- Sophomore Junior Senior Honors Program M.A./M.S. Student Ph.D. Student Major:   GPA: For Graduate Students only: Are you a Teaching Assistant? Yes No      If Yes, Give your TA status: Full-time Part-Time Previous Tutorial or Teaching Experience: Year(s) Place Course(s) Courses/Subjects Qualified to Tutor: NB:CPIA will review your transcript for verification.   Do you work in another department on campus? Yes No If Yes, Department: Hours Per Week: Are you on work study? Yes No   How many hours are you interested in working at CPIA?   Days and Times Available to Tutor   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Morning Afternoon Evening What special qualities, characteristics, or experiences would make you an effective tutor for the Counseling Program for Intercollegiate Athletes? Explain: