Achiever's Academics

Teacher's Application

Date

First Name

Last Name

Cell Phone Number

Email Address

Address

City

State

Zip

Are you currently or were you previously certified?

State

Exp. Date

Subject/s

Latest Degree Earned

Area of Study

University and Graduation Date

Please list any experiences you have had teaching or tutoring students with learning disabilities, ADD, or ADHD, if any.

Name/s of Learning Disability/ies

Did they have any of the following accommodations?

RTI

IEP

504

What are your preferred grades, subjects, days, and times?

Grade/s

Subject/s

Day/s

Time/s

Teaching Experience:

1) School or District Name

City, State

Grade/s

Subject/s

Supervisor's Name

Phone

2) School or District Name

City, State

Grade/s

Subject/s

Supervisor's Name

Phone No.

Do you have any experience teaching/tutoring online?

Yes

If yes, how many years and/or months?

If yes, what platform/s do you have experience with?

What subject/s do you or did you teach?

1) Company/Organization

Phone

2) Company/Organization

Phone

1) Personal Reference

Phone No. or Email address:

2) Personal Reference

Phone No. or Email Address

I agree that all of the above information is true and I agree to a background check.

Signature & Date

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Tutored by Teachers

Achiever's Academics

1-910-420-4208