* 1. Name:

2. Address Information:

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

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

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

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

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

* 8. Do you have reliable transportation?

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

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

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

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

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

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

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

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

17. Any Other Details (not mentioned above):