2021-22 STEMWorks Tutor Application Form

Volunteer Application Form

Welcome to the STEMWorks Program! Thank you for sharing interest in giving back to our community. STEMWorks is a program designed to provide Black youth in Durham Region (ages 13-19) a safe space to learn, access to supportive resources they can use in their academic and career development, and opportunities to foster personal growth. As a team, we are committed to servicing youth who are not only experiencing systemic barriers but who are also pushing to fight against the discouraging consequences of these barriers which often deter our youth from obtaining careers in medicine, allied health and other STEM professions. We thank all applicants, but only those chosen for an interview will be contacted.
Volunteer Applicant Information
Full Name*

First NameLast Name
Birth Date

MonthDayYear
What is your Race/Ethnicity? (please select all that apply.)

Indigenous (First Nations, Métis, Inuit)Black (e.g. African, Caribbean, North American, Afro-Latin American)East Asian (e.g. Korean, Japanese, Chinese)Indo-Caribbean (e.g. Guyanese, TrinidadianLatin American (e.g. Colombian, Ecuadorian, Chilean)Middle Eastern (e.g. Iranian, Syrian, Iraqi, Lebanese)South Asian (e.g. Indian, Pakistani, Sri Lankan)Southeast Asian (e.g. Filipino, Vietnamese, Cambodian)White/CaucasianUnknownPrefer not to sayOther
Residence and Contact Information
Address*

Street Address

Apartment, Unit or

CityState / Province

Postal / Zip Code
Email*

Confirmation EmailConfirm Email
Mobile*
Please enter a valid phone number.
What is your preferred method of communication?

EmailPhone callTextOther
How did you first hear about the STEMWorks Program (Select all that apply.)*

Social MediaFrom the Volunteer Durham WebsiteFrom reading a News OutletFrom a Friend/FamilyFrom a Community Member/EventThrough Google SearchFrom the Black Physicians of Tomorrow WebsiteOther
Tell us more about YOU!

Please take a moment to reflect on the following questions below and answer each question to the best of your ability.
Can you tell us about an aspect of a previous volunteer experience that you've really enjoyed and a part of that experience that you wish had been different?*
In 50 words or less, please describe why you want to be a volunteer within our organization to serve the community? (Entry limit is 50 words).*

0/50
Why do you think this volunteer opportunity is a good match for you?*
In 20 words or less, what gets you up in the morning? *

0/20
Please share and describe five skills you believe you would bring to the STEMWorks Program. Please include a number before describing each skill for clarity.*
Have you tutored students before? If your answer is yes, tell us about it here. If you haven't tutored students before, that's okay. You can put in this box below, "I haven't tutored students before."*
When can you start working for us?*
Within the STEMWorks Program, our staff and volunteers support students ages 12- 19. Please enter the grade(s) you would be most comfortable tutoring. Select all that apply.

Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12All of the above
Do you have a Diploma?*

YesNo
Please state which
Do you have a Degree?*

YesNo
Please state which
Do you have a Teacher Certificate?*

YesNo
Please state which
Are you working towards a Teaching Qualification?*

YesNo
Please state which
Do you have any other qualifications?*
Do you have a Vulnerable Sector Police Reference Check?

YesNo
Please tell us more about yourself by responding the following questions below.
Do you have access to a vehicle?*

YesNo
For further clarity, please select below the method of transportation will you be using.
Are you currently employed?

YesNo
Are you able to work Saturday mornings from 10am - 12pm?

YesNo
Are you currently going to school either full-time/part-time?

YesNo
Please tell us of any special skills you may have.
Have you worked with children with physical disabilities?

YesNo
If yes, please tell us more
Have you experience of developmental disabilities or disorders e.g.ADHD?

YesNo
If yes, please tell us more
Please tell us a little more about yourself, what motivates you, your passions and plans.
We aim to provide a great match between the tutor and the student. This enhances the learning experience and adds real value to the student and the tutor. To help us make this match give us some idea of your interests, hobbies, favourite subject to teach, etc.
Please provide the names of two organisations or professionals we can use as references. (These cannot be family or friends)
First referee
Name*
Telephone*
Email*
Profession/Relationship*
Second referee
Name*
Telephone*
Email*
Profession/Relationship*
Browse you computer or network to upload your Resume/CV
Upload your Resume/CV*

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Browse you computer or network to upload your Profile Picture
Upload your Picture*

Optional
Cancelof
Browse you computer or network to upload your CRB (If applicable)
Upload a copy of your Vulnerable Sector Police Reference Check. If you don't have one, please complete this form and send us an email notifying our Program Coordinator of your current status. We will reimburse the costs associated with this request. Thank you.

Cancelof
Do you know anyone else that would be a great tutor for the STEMWorks Program?

If you answered yes, please feel free to connect them to us via email.
YesNot at this time
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Volunteer Application Form

Volunteer Applicant Information

Residence and Contact Information

Tell us more about YOU!