RoleModels University Volunteer Application Form

RoleModels University Volunteer Application

P.O. Box 32312 Charlotte, North Carolina 28232-2312 Telephone: (980)322-6040 Email: rolemodels_is@yahoo.com www.rolemodelsuniversityedu.org
Name Full Name
Gender

MF
Todays Date

MonthDayYear
Date
Racial Identity
Driver License Number
Birth Date

MonthDayYear
Date
Home Phone
Cell Phone
Social Security Number
Work Phone
What is the best way to contact you
Email
example@example.com
Street
Apt
City
State
Zip
Mailing Address (if different):
PO BoxStreet
City
State
Zip
References Please list three persons familiar with your character.
- All must have known you for at least a year
- At least one reference must be a work or school reference
- At least one reference should be familiar with your home environment (This person may be a family member)
Name, Address, City, State, Zip, Phone
Name, Address, City, State, Zip, Phone
Name, Address, City, State, Zip, Phone
Legal Record

Please list any arrests, convictions and recent traffic violations.
Arrest or Violation Date, Charge, and Result
Arrest or Violation Date, Charge, and Result
Arrest or Violation Date, Charge, and Result
Please provide a copy of your resume.

If you do not have a resume then complete the fields below.
Current Employment
Start Date
End Date
Company
Type of Business
Address
Phone / Email
City
State / Zip / Code
Your Position
Your Manager
Reason for Leaving
Job Description
Previous Employment
Start Date
End Date
Company
Type of Business
Address
Phone / Email
City
State / Zip / Code
Your Position
Your Manager
Reason for Leaving
Job Description
EDUCATION HIGHEST LEVEL OF EDUCATION
HIGHEST LEVEL OF EDUCATION
SCHOOL LOCATION
DATES ATTENDED

MonthDayYear
Date
GRADUATED DEGREE
RoleModels University Application - Confidential
Would you like to serve as a RoleModel (mentor) to a student at RoleModels University? If so; complete here:
RoleModel (Mentoring) Options (fill in the circle for all that apply)

RoleModelCounselor - RoleModelGeneral - RoleModelBoysGirls5-10 ages (Elementary)11-15 (Middle School)16-19 ages (High School)
If you chose Career, specify career field
If you chose Counselor, specify area of counseling
As a RoleModels University Teacher, what ages would you like to teach?

5-10 ages (Elementary)11-15 (Middle School)16-19 ages (High School)
Volunteering Options - Would you like to actively volunteer?

YesNo
Specify all interest areas for volunteering: (ex: teaching, fundraising/development, volunteer recruitment-manager, seasonal, special event volunteer, etc.)
"Why are people poor?"
Complete application in its entirety. Obtain a Civil & Criminal background check at your local courthouse (this ONLY applies if you desire to work directly with RMU students for example: teachers, mentors etc If you desire to make a donation; please visit our website and/or make all checks/money orders payable to RoleModels University and mail to the address provided below.

RoleModels University

P.O. Box 32312

Charlotte, NC 28232-2312
Commitment and Release

1.I understand that RoleModels University (RMU) is a Faith Bible-Based Organization.

2. I understand that all volunteers, mentors and staff positions, with the exception of special events volunteers, require workshop/training in Racial Equity.

3.I understand that all volunteers and staff positions require an interview process.

4. I will commit to RoleModels University (RMU) for a minimum of one (1) year of volunteering.

5. I understand and agree that donations to RMU are optional and I am not required to make a financial donation.

6. I realize that if I choose to mentor a RoleModels University student, then I will have the title, RoleModel, as a mentor, to a student at RoleModels University.

7. I realize that RMU reserves the right to terminate my volunteerism if I am convicted of a crime misdeemeanor/felony, with the exception of a speeding ticket, and RMU reserves the right to withhold information regarding reasons of termination.

8. I understand that application will be held confidential within the corporate records of RoleModels University. I have read above the commitment and understand and agree to its contents.
Print Name
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
RoleModels University Application - Confidential
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