Date:   

School:

Name:

Subject Areas:

Grade Level:

1. Why do you want a tutor in your classroom? What are your goals?

2. What specific role do you see the tutor performing in your classroom? How would you utilize a tutor (e.g., individual or small group pull-outs, going over an assignment, specific skill building, remediation, enrichment, etc.)?

3. Would you be comfortable with a combination of students being chosen by yourself and by the tutor?
Check if Yes - Unchecked if No

4. What is your schedule? (lunch, supplementals, prep, gym, recess. etc)

5. Would you be open to occasionally co-facilitating a teaching session/activity with a tutor?
Check if Yes - Unchecked if No