1. Volunteer Information

* 1. Please enter today's date


* 2. Please complete the following:

* 3. Strongest Subject Areas:

* 4. Availibility (Days of the Week):

* 5. Availibility (Time of Day):

* 6. Please list languages other than English:

* 7. Please indicate civic affliations:

* 8. Please describe previous volunteer experiences:

* 9. Reference:

* 10. Emergency Contact Information:

* 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.

* 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.

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