Adult Volunteer Application

Adult Tutoring Volunteer Application
Full Name
First and Last Name
Date Available

MonthDayYear
Date
Address
Street and City
Date of Birth:

MonthDayYear
Phone
Format: (000) 000-0000.
Email
example@example.com
Preferred Method of Contact:
TutoringCheck-in/out & Bathroom EscortSnack set up and clean upProvide snacks
Education
High School Attended:
City/State
From
To
Year Graduated
Diploma
College Attended
City/State
Year Graduated
Diploma
Other Training, Schooling
City/State
Year Graduated/Certified
Diploma/Certification
References - please list three references.
Reference #1
Relationship
Years known
Company
Phone
Format: (000) 000-0000.
Reference #2
Relationship
Years known
Company
Phone
Format: (000) 000-0000.
Reference #3
Relationship
Years known
Company
Phone
Format: (000) 000-0000.
Disclaimer and Signature

I understand that false or misleading information in my application or interview may result in my release from volunteering.

I certify that my answers are true and complete to the best of my knowledge.

If volunteering directly with children, and agree to a formal background check and to complete the Child /Youth Protection Policy training.
Signature

Clear
Date

MonthDayYear
Date
Photography and Video Notice: Your participation in this program constitutes your consent for you to be photographed, filmed, and/or otherwise recorded and to the release, publication, exhibition, or reproduction of any and all recorded media of your appearance, voice, and name for any purpose whatsoever in perpetuity in connection with Mason Community Services, Inc. and its initiatives, including, by way of example only, use on websites, in social media, news and advertising.
Should be Empty:

Education

References - please list three references.