Volunteer Application

Volunteer Application
Volunteer Information
Date

Month Day Year
Date
Name
Phone
Email Address
Address

Street Address

Street Address Line 2

City State

Zip Code

Volunteer Profile
Have you ever worked or volunteered with Project Learn?

Yes No
If yes, when and in what capacity?
Do you know anyone who works or volunteers with Project Learn?

Yes No
If yes, whom?
Relationship to you
Are you volunteering to meet a requirement?

Yes No
If yes, please explain.
Where did you learn about volunteering at Project Learn?
Why do you want to volunteer at Project Learn?
Current employer (if applicable)
Do you have previous volunteer experience?

Yes No
If yes, please name the organization(s) and describe the duties performed.

Emergency Contact Information
Name
Relationship
Phone

Language Skills

Though instruction is offered strictly in English, being proficient in other languages can be helpful for students during the registration process.
Are you proficient in any language(s) other than English?

Yes No
If yes, which languages? Please indicate your proficiency level of speaking, reading, and writing for each language.

References
Please provide the names of two people you know who are over 18 years of age and who are not your relative(s).
Reference 1 Name
Relationship to you
How long have you known this person?
Reference 1 Phone
Reference 2 Name
Relationship to you
How long have you known this person?
Reference 2 Phone

Background
Have you every been convicted of a crime (excluding traffic violations, unless alcohol or drug related)?

Yes No
If yes, please list the date(s) and explain the conviction.
Please note: Project Learn may require applicants to submit a background check and fingerprinting for suitability as a volunteer for the organization. Project Learn reserves the right to deny an application based on criminal history records. While a conviction doesn't necessarily disqualify an applicant, failure to disclose this information to Project Learn will result in termination or disqualification of an applicant. Additionally, volunteers must agree to inform Project Learn immediately of any changes to their criminal record/history within five business days of the event.

Our Policy
It is Project Learn of Summit County’s policy to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
Media Release Agreement
I give my permission for the use of photographs and video taken of me during the hours of my volunteer experience with Project Learn. These photographs may be used to describe Project Learn's programs in any proposals, or presentations in any form, including slides, news articles, or websites. Only first names will be used, if any, in any publication, and no volunteer's personal details will be published unless express permission is granted by said volunteer. My permission is given without restriction. I hereby relinquish all rights to the final use of any media published in the name of Project Learn that contains my image, voice, or likeness.
Yes, I agree No, I disagree
Agreement & Signature
I certify that the information I have provided in this application is true and complete to the best of my knowledge. I understand that if any information given is not true, I may be denied volunteer placement or dismissed from my service. If accepted as a volunteer, I will comply with the values, policies and procedures of Project Learn. I clearly understand that, as a volunteer, I am not entitled to compensation or fringe benefits of any kind. I also authorize Project Learn to conduct a background check. I understand that I will be volunteering at my own risk. I hereby release and hold harmless Project Learn of Summit County, its employees, directors, officers and agents from any and all claims, costs, damages, losses, liabilities, including attorney fees or expenses related to Project Learn's processing and accepting this application.
Signature

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Volunteer Application

Volunteer Information

Volunteer Profile

Emergency Contact Information

Availability and Interest

Language Skills

References

Background

Our Policy

Media Release Agreement

Agreement & Signature