Literacy Tutoring & Mentoring
Volunteer / School Intern Registration Form
Today's Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Birthdate
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Month
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Day
Year
Date
Age
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Gender
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Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
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Other Phone
What Spoken Languages do you speak, other than English?
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How did you hear about this In-Person Tutoring / Mentoring Initiative?
I would like to be a :
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Literacy Volunteer in a DOE School
School Liaison
Back-up Volunteer
Literacy Volunteer in Community Center (Sat. Only)
What High School / College did you attend or are currently attending? (please give most recent)
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What is / was your Field of Study?
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What was / is your Occupation? (students can put temp jobs or N/A)
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Past Experience as a Tutor or Teacher? Y/N (experience is not required)
Church you Attend / Ministry Org. / Volunteer Org. (If any)
Ministry Involvement / Other Volunteer Work (If any)
Are you able to Volunteer/Intern during school lunch hrs.(typically from 10am-1pm)?
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Yes
No
Are you able to Volunteer/Intern during after school hrs.(typically from 2:30pm-5:00pm)?
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Yes
No
What days are you available? (Please select all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (11am-1pm for Community Center Volunteers only)
How many days a week would you like to volunteer / intern? (one day is the minimum for Schools)
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For Community Centers, which Saturday(s) of the month would you like to volunteer / intern? (check all that apply)
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1st Sat.
2nd Sat.
3rd Sat.
4th Sat.
Not Applicable
I would like to be paired with another Volunteer. (Please share in the comments if you anticipate being absent at a particular time & why.)
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Yes
No
My school is offering me an internship
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Yes
No
Not Applicable
How many children would you be able to help at one time? (1-2 is preferred, 4 children is maximum)
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1 child
2 children
3 children
4 children
If needed, would you stay for additional periods of the day and help more children? (For ex: 1 pd is 45 min., 2 pds are 90 min., 3 pds are 2hrs:15min.)
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Yes, 2pds
Yes, 3pds
Only 1 pd
Please indicate the grade level of the student you would prefer to tutor and mentor. (Preferences are not guaranteed)
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Kindergartener
1st Grader
2nd Grader
No Preference
Please advise what size Volunteer T-Shirt you would need
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Small
Medium
Large
X- Large
XX- Large
Kindly advise if you have a school / community center preference. (Preferences are not guaranteed)
What Questions, Comments or Concerns do you have? (if any)
Will you comply with a Background/Fingerprinting check?
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Background Check & Fingerprinting Instructions with Identigo are sent to your Email. If you have already registered with Identigo before, you do not need to do it again. (There is no cost to you for fingerprinting)
Literacy Tutors & Mentors are expected to be Faithful in their Commitment to help the Children on their assigned days & times, on a weekly basis, for the Length of the Program.
Thank you for Signing up to Be a Literacy Tutor & Mentor.
Blessings!
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