LDAWC Volunteer Tutor Application Form for Reading Rocks Program

LDAWC Volunteer Application Form for Executive Functioning Program
OUR MISSION STATEMENT
The Learning Disabilities Association of Wellington County (LDAWC) is a charitable, nonprofit organization dedicated to improving the lives of children, youth and adults with learning disabilities so that they can reach their full potential. Through outreach, education, advising and advocacy, the Learning Disabilities Association of Wellington County's mandate is to advance the education, employment, social development, legal rights and general well being of individuals with learning disabilities.

BECOMING A VOLUNTEER TUTOR

Join our Executive Functioning program, designed for youth ages 10-16 to build self-regulation skills in a supportive, small group setting. This program will accommodate one group of eight to ten children total.

All new tutors must attend a mandatory training/orientation session that will be held roughly a week before the program begins. Time Commitment: This program runs from February 3 - April 7, offering one evening session per week for 8 weeks (from 6:30-7:30pm) at a centrally located site in Guelph. You must be a minimum of 16 years old to apply to tutor.

All tutors aged 18+ must have a current Police Vulnerable Sector Check clearance issued within one year of the start of the program.

PROGRAM DATES

Winter 2025:
Guelph: Febuary 3 - April 7

6:30pm-7:30pm

Location: John F Ross CVI

Thursdays (tentative)

Volunteer Responsibilities:

*Commit to the entire program.

*Participate in weekly sessions to support youth in developing self-regulation skills.

*Engage with and mentor youth to foster a positive and inclusive environment.

*Collaborate with the facilitator to deliver structured activities and exercises.
When would you like to volunteer? (Please check all that apply)

Fall 2024
* required
Your Name*

First NameLast Name
Your E-mail Address*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Please Indicate Your Preferred Days to Tutor*

Monday and Wednesday (6:30-7:30 pm)Tuesday and Thursday (6:30-7:30 pm)I could tutor on either M/W or T/T
Are you fluent in the English language?*

YesNo
Are you able to commit to one day a week, 6:30pm-7:30pm from Feb. 3 - April 7?

YesNoNot sure

Please indicate your preference for when to tutor/volunteer

	1st Choice	2nd Choice	3rd Choice	Not Available
Mondays 6:30-7:30 pm
Tuesdays 6:30-7:30 pm
Wednesdays 6:30-7:30 pm
Thursdays 6:30-7:30 pm
Friday 6:30-7:30 pm

What is your educational background?*
Have you had experience working with children or mentoring children? Please describe:*
Have you had previous volunteer experience? At what organization(s) and what did you do?*
Do you have a Vulnerable Sector Check that has been issued within the last 12 months? (for those 18 years or older)*

YesNo
Do you have any other experience that is relevant to this position?*
What are some of your interests and strengths? (We use your answer to help match you with a student.)*
Please briefly describe your familiarity with the concept of executive functioning?*
What do you think makes you a suitable mentor in our EF Program?*
Please describe your knowledge of Learning Disabilities and Attention Deficit Hyperactivity Disorder (ADHD)*

Please rate your skills and qualifications in the following:*

	No experience	Some experience	Extensive experience
Tutoring/Teaching
Mentoring/Coaching
Use of Microsoft Teams
Interpersonal communications
Lesson/program planning
Time management
Creativity
Organization
Behaviour management
Reliability and punctuality

Is there any other information you would like to share?
How did you hear about our organization?*
References

Please note we need 2 references. Family members and friends cannot be references. Please provide name, relationship (e.g. supervisor, teacher, coach), phone number and email address.
Reference One (name, relationship, phone number, email address:*
Reference Two (name, relationship, phone number, email address:*
Terms and Conditions
1. I hereby authorize photographs and/or videotaping to be taken of me while at the Learning Disabilities Association of Wellington County (LDAWC) for the purpose of promoting the program.

2. I understand that the information collected on this form will only be used to assess my eligibility for the position. This information will only be shared with LDAWC staff and Board. I give permission to Learning Disabilities Association of Wellington County to contact the persons listed as my references for the purpose of obtaining reference information. These persons are aware that LDAWC may contact them and have my permission to discuss information regarding my current and/or previous employment.
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LDAWC Volunteer Application Form for Executive Functioning Program

References

Terms and Conditions