Tutoring Academy - Application Form

Below are a short number of questions that we require parents to fill in if they are interested in having their children take part in the voluntary learning opportunity we have set up.
Our priority will be to help those who are from ethnic minority backgrounds and may not have as much opportunity as other children of a similar age.
The questions that you answer and the details you provide about your child will be treated in the strictest confidence and only viewed by those dealing with the application. For further information or help with filling out this form place contact Empower on 07886264142 or email info@empower-youth.org.uk
The form must only be filled in by the child's mother/father or guardian.

Full name of child (required)

Your Email (required)






Number of brothers and sisters

Telephone numbers(s): This must include the numbers of both parents who could be contacted about the child

Who does the child currently reside with?

Does your child receive free school dinners?

Question about the parent/guardian

How are you related to the child?
(if other) please state

What is your ethnicity:
(if other) please state

Do you or your partner work:

If yes, what is your occupation:

What is your partner's occupation:

Has anyone from the immediate family attended university ('immediate' only includes the child's mother, father or brothers and sisters):

If yes please state who and what they studied for their degree:

The teaching sessions will be taking place at the Highfields Community Centre on Sundays between 12.30 - 3pm.* Will you be able to ensure that your child is able to attend on a weekly basis:

Your child's health

The next few questions will not affect your child's application process but are important for us to be aware of in case of an emergency.

Does your child suffer from any medical conditions? [for example asthma/diabetes/epilepsy]

If yes please state what and how if affects your child:

Does your child have any allergies?

If yes please state

EMPOWER will not accept any liability for any loss, damage or injuries to persons or property whoa ttend this event in any capacity.