Student Volunteer Application
Name
First Name
Last Name
WIU ID
Year in School
Please Select
Freshman
Sophomore
Junior
Senior
Grad Student
Major
Minor
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can you submit the required DCFS proof of a physical exam that provides evidence that you are free of tuberculosis, and physical or mental conditions that could affect your ability to perform assigned duties?
Yes
No
Mandated reporter certificate
Yes
No
List Past Work Experience
List ECE classes or child development classes you have taken
Do you have experience with...
Infants (6 weeks to 15 months)
Toddlers (16 to 24 months)
Two-year olds
Preschoolers
Class Schedule
Other Days/Hours NOT available to work
Submit
Should be Empty: