Volunteer Counselor Application Form
Personal Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Residence Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Basic Requirements
Are you legally entitled to work in the United States?
*
Are you 18 years of age or older?
*
Do you understand that applicants will be required to provide a current, valid Driver’s License, a Criminal Record Check, and a Drug Test?
*
Do you understand that applicants will be required to provide a current, negative Covid test?
*
Do you believe you are free of medical conditions that may inhibit your participation as a volunteer counselor?
*
Counselors are expected to offer homework help to our students. Please select the subject area(s) that you feel most confident in providing assistance:
English/Language Arts
Math
Science
Social Studies/History
Foreign Language
Additional Comments
Availability
While the expectation is that you will be available daily, please select your availability below.
*
Monday
Tuesday
Wednesday
Thursday
Friday
Skills and Experience
Please indicate if you have any of the following skills or training
*
CPR - Cardiopulmonary resuscitation
First Aid
Other
Previous Volunteer, Counselor, or Tutor Experience - Explain your role or responsibilities:
References
Please provide a reference below.
Terms and Conditions
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: