* 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):

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