2011-2012 Volunteer Application Form

First Name: *

Last Name: *

Are you a new or returning volunteer?: *

New Volunteer

Returning Volunteer

If you are a returning volunteer, what years have/did you work with us?:

If you are a returning volunteer, what trainings have you attended?:

Elementary Reading (Raceway or Language)

Adolescent Reading (Wilson)

Math

Tester

When was your most recent training? (Month and Year):

Current Address: *

City: *

State: *

Zip Code: *

Email:

Are you employed?:

Yes

No

Employer:

Title:

Does your employer (check all that apply)::

Encourage staff to volunteer/provide release time

Match donations

Cell Phone:

Work Phone:

Home Phone:

Best Way to Contact You:

E-mail

Home Phone

Cell Phone

Work Phone

Personal Information

Birth Date (Month/Day/Year):

Age:

Gender: *

If other, please describe:

What languages do you speak?: *

English

Spanish

Other

If other, please describe:

Educational Information

What is the highest level of education you have completed?:

If you are currently in college, what year are you in school?:

If you are currently in college, which college/university do you attend?:

If other, which?:

If you are not currently attending college, please list any colleges/universities you did attend.

Alma Mater 1:

Alma Mater 2:

Alma Mater 3:

Are you working with FLOC as a work-study student?: *

Are you volunteering with FLOC as part of a college course?: *

If yes, please give course info::

School:

Professor:

Course ID:

Course Name:

Other Information

Please provide specific details regarding how you heard about FLOC (Ex: flyer location, specific website, etc.):

Placement Information

Neigborhood Tutoring Program (NTP):

Tutor (required to come at least 1 time per week)

Substitute/Tester (required to come at least 1 time every 2 weeks)

Identify the program days/times that fit your schedule and interests. (Check all that apply):

Tuesdays @ Tubman Elementary 3:15-6:00pm, 1st - 5th Grade Reading

Tuesdays @ FLOC Office 5:45-8:15pm, 3rd - 12th Grade Reading (limited space available)

Wednesdays @ Ross Elementary 3:15-6:00pm, 1st - 5th Grade Math (PROGRAM FULL)

Thursdays @ Malcolm X Elementary 3:15-6:00pm, 1st - 5th Grade Math

Thursdays @ FLOC Office 5:45-8:15pm, 3rd - 12th Grade Math (limited space available)

Saturdays @ Center City Congress Heights Elementary 9:45-12:15am, 1st - 5th Grade Math

Saturdays @ FLOC Office 9:45-12:15am, 1st - 12th Grade Math (PROGRAM FULL)

Saturdays @ FLOC Office 1:15-3:45pm, 1st - 12th Grade Reading (PROGRAM FULL)

Scholars Expert Workshop Facilitator:

Session 1 (January 2012)

Session 2 (March 2012)

Session 3 (May 2012)

(share your expertise; plan and facilitate 1-4 workshops Mon. and/or Wed. from 4:30 pm-7:00pm)

Scholars Program Facilitator:

Monday 4:30 pm - 7:00 pm (Middle School)

Wednesday 4:30 pm - 7:00 pm (High School)

(work with FLOC staff to ensure quality workshop experiences for groups of middle-school and high-school Scholars.)

Your Motivation and Commitment (Please answer in complete sentences.)

Do you have any previous experience tutoring, mentoring, or volunteering with youth?: *

If yes, please describe.:

Why do you want to volunteer with For Love of Children?:

Is there anything that may hinder your commitment to FLOC or to your student(s)?: *

If yes, please explain.:

If other, what?:

Emergency Contact Information

Full Name: *

Relationship: *

Email:

Cell Phone:

Home Phone:

Work Phone:

Best Way to Contact:

For Love of Children Teach. Empower. Transform.

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