Work Exchange 2022-23 Application (ENGLISH)

Work Exchange/Volunteer Application Fall 2022-23
Are you applying for Work Exchange or Volunteer? Please check one below:

Work Exchange Volunteer
Name

First Name Last Name
Address:
Apt.
City:
State:
Zip Code:
Home Tel:
Cell:
Work
E Mail:
example@example.com
Name of student for whom you will do work-exchange or indicate if it will be for your own class:
Are you fluent in any language other than English?

YES NO
If you answered yes, below please input other language:
List below the class for which you want to do work-exchange.

(Please note: A one hour dance class or group music class equals 3 hours of work each week, and a 1.5-hr dance class equals 4 hours of work each week. Work-Exchange is limited to one class per student. The 2nd class is allowed only with the permission of a supervisor).
1. Class:
Hrs. required
2. Class:
Hrs. required
Preferred/Requested Tasks/Duties: (Please check all that apply)

Telephone/Reception Filing Proposal Writing for Fundraising Marketing/PR Art/Graphic Design Child Care/Hall Monitor Maintenance Sound Engineering Virtual Clerical Assignments Virtual Class Assistant Other
Please enter all days and times you are available:

(example: 3:00pm to 4:30pm)
Tuesday
Wednesday
Thursday
Friday
Saturday
Work Experience:
Name & Address of Employer 1
Dates Employed
Title & Duties
Reason for Leaving
Name & Address of Employer 2
Dates Employed
Title & Duties
Reason for Leaving
Education

Please start with last school attended
School Name 1
Course of Study/Degree
Graduated

Yes No
School Name 2
Course of Study/Degree
Graduated

Yes No
References

List two professional references
Name/Affiliation
Phone
Name/Affiliation
Phone
I hereby confirm that all information on this application is accurate and complete to the best of my knowledge:
Applicant's Signature:

Clear
Today's Date:

Month Day Year
Date
Applicant Agreement:
I understand that I am required to attend orientation; that this commitment is similar to a paid job, and that I am responsible to work at Mind-Builders for the agreed upon amount of time. If for any reason I am unable to work at the scheduled time, I will notify Mind-Builders in advance and schedule a make-up time within the same month. If I am not able to do this, I agree to pay the portion of tuition that is owed. I also understand that to receive credit for my work exchange, my timesheet must be completed each day and signed by a staff member.
(Please Initial)
DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY
Skills Assessment:
Work Exchange Schedule:

example: (3:00pm-4:30pm)
Tuesday
Wednesday
Thursday
Friday
Saturday
Total Req. Hours
Approved Work Exchange Classes:
Student Name
Class Name
Monthly Credit
Total Required Hours
Approved for Work Exchange by:
Date:

Month Day Year
Date
Supervisor's Signature:

Clear
Should be Empty:

Work Exchange/Volunteer Application Fall 2022-23

Work Experience:

Education

References

Applicant Agreement:

DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY

Work Exchange Schedule:

Approved Work Exchange Classes:

Total Required Hours