Exit this survey

1. Volunteer Information

Question Title

* 1. Please enter today's date

Date

Question Title

* 2. Please complete the following:

Question Title

* 3. Strongest Subject Areas:

Question Title

* 4. Availibility (Days of the Week):

Question Title

* 5. Availibility (Time of Day):

Question Title

* 6. Please list languages other than English:

Question Title

* 7. Please indicate civic affliations:

Question Title

* 8. Please describe previous volunteer experiences:

Question Title

* 9. Reference:

Question Title

* 10. Emergency Contact Information:

Question Title

* 11. Statement of Confidentiality - Volunteers, like instructors, are required to comply with policies that protect confidentiality and disclosure of student records and personal information that they become privy to as a result of working directly with the students. Disclosure of student records and personal information beyond program personnel and consultants having obligation of confidentiality, shall require written consent from the adult student.

I understand the above statement and will comply with the policy to maintain confidentiality and to respect the student's right to privacy, refraining from disclosure or confidential information and intrusion into the student's family life.

Question Title

* 12. Do you authorize the administration to use your picture in publications, brochures, flyers, displays and other promotional materials.

Please select PRINT on your browser menu bar prior to selecting DONE to keep a record of this application for service.

Question Title

* 13. How long do you anticipate committing to the program (1 month, 3 months, etc.)?

T