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* 1. Name:

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* 2. Address Information:

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* 3. What phone number would be the best for contacting you?

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* 4. At what email address would you like to be contacted?

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* 5. What is the name of the school closest to your home?

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* 6. What days are you available? Please note all that apply.

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* 7. What time of day are you available? Please check all that apply.

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* 8. Do you have reliable transportation?

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* 9. How far are you willing to drive? Please check the furthest distance.

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* 10. In what languages can you speak, write or read? (Check all that apply)

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* 11. If currently attending college, what is your college major?

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* 12. What time of year are you available to volunteer? Check all that apply.

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* 13. Would you like to work with adults or girls?

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* 14. If girls, what grade levels would you be most comfortable assisting? Please check all that apply.

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* 15. What are your favorite things to do, ex. science, math, reading, dance, art, music?

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* 16. What specific skills do you have (ie. sewing, cooking, knitting):

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* 17. Any Other Details (not mentioned above):

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