Volunteer Registration Form

Learning for Life Program

Personal Information Date:

Name:
First M.I. Last
Address:
Street Address Apartment/Unit #

City State ZIP Code

Primary Phone: ( ) Alternate Phone: ( )

E-mail Address:

Birth Date: Please contact me by: Mail E-mail Phone

Sex? Male Female Hispanic, Latino or Spanish? No Yes

Race(s)? White Black Asian Native: Other:

Background Information

Highest degree completed:

How did you find out about us?

I feel comfortable tutoring…

Low Level: Reading & Writing Math English Skills

Intermediate to GED Prep: Reading & Writing Science Social Studies Math

Other:

Location: WSCC St Colman Thea Bowman

Emergency Contact Information

Name:
First M.I. Last

Primary Phone: ( ) Alternate Phone: ( )

Relationship:

Any important info in case of emergency?

Please complete side 2…

Duplication & modification permitted for non-commercial purposes © 2010 West Side Catholic Center Learning for Life Program
 Volunteer Registration Form
Learning for Life Program

Additional Information

Please add me to your mail/email list! Yes No

Do you have any special needs that require reasonable adaptations to tutor?

Are you interested in any additional volunteer roles beyond tutoring? Yes No

Site Manager Clerical Advisory Board Party Planning Marketing

Assessment Other:

Duplication & modification permitted for non-commercial purposes © 2010 West Side Catholic Center Learning for Life Program