8500 14th Ave NW, Crown Hill UMC

Seattle, WA 98117

Phone 206-233-9720                                   

                          
                                      VOLUNTEER APPLICATION

1. Key Information:
Last Name: _____________________ First Name: ____________________ Middle Initial: __________
Address: _____________________________________________________
City: ___________________ State: _____________ Zip: ____________
Email: ______________________________________
Home Phone: _________________________________ OK to call home? Yes ___ No ___
Work Phone: ________________________ Ext: _____ OK to call work? Yes ___ No ___

* Tutor and student contract by mutual agreement.  Volunteers are not employees.  Please initial
to acknowledge ____________.

2. DEMOGRAPHICS:
Gender: M ___ F ___ Birth Date: ________________ Ethnicity: _________________
Married? Yes ___ No ___ Education Level: _______________ Degree: ____________
Employed? Yes ____ No ____ Occupation: ____________

3a. Please check skills and experience you have acquired in your education, jobs, or volunteering (check all that apply):
Writing ___ Fundraising ___ Data Input ___ Library Skills ___ Phone Contacts ___
Administrative Skills ___ Teaching Children ___ Tutoring Adults ___ Public Speaking ___ Other ___

3b. Please list your interests, hobbies, and travel experience (to help us match you with a student who shares your interests):
______________________ | _________________________ | ________________________
______________________ | _________________________ | ________________________
Fluent in what foreign language? _______________
Willing to translate? Yes ___ No ___

4. WHY DO YOU WANT TO VOLUNTEER FOR LITERACY? 
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

5. PLEASE INDICATE THE DAYS AND TIMES YOU CAN VOLUNTEER:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

6. PLEASE CHECK WHAT YOU ARE INTERESTED IN DOING FOR LITERACY (check all that apply):
*TUTORING
English as a Second Language ___ Adult Basic Education ___
Small Group Tutoring ___ Advanced Pronunciation ___ Tutor Training ___

*ORGANIZATION SUPPORT
Fundraising Events ___ Social Events ___ Grant Writing ___
Community Outreach ___ Publicity ___ Board Member ___

*OFFICE SUPPORT
Computer Input ___ Correspondence ___ Office Assistance ___
Librarian ___ Newsletter Production ___ Short-term Projects ___

7. PREFERRED STUDENT PROFILE (age, gender, country of origin): _____ / ________ / __________

8. HAVE YOU EVER BEEN CONVICTED OF A FELONY?  Yes __________  No ___________

9. Please Provide a Personal Reference:
Name: _______________________________
Phone: _______________________________ Best time to call: __________
Address: _____________________________________________________
City: ___________________ State: _____________ Zip: ____________
Relationship: ________________________

Please read before signing: I acknowledge that the above information is true and correct. I give my permission for LCS to perform a State Patrol Background check if required.

Applicant's Signature:  ____________________________  Date:  _______________


TO REGISTER FOR THE ESL TUTOR TRAINING WORKSHOPS, PLEASE COMPLETE THIS SECTION:

PLEASE REGISTER ME FOR THE ESL TUTOR TRAINING WORKSHOPS ON (DATES):
__________________ AND ____________________

ATTACHED IS MY $40 CHECK FOR TRAINING MATERIALS.


LCS STAFF USE ONLY

Date Received:  _____________  Reviewed by:  ___________  Date Applicant Notified:  _____________