Tutoring Program
Volunter Application Form

The information you provide on this form will allow us to learn more about you, before you are matched with a student..

NAME:: DATE:
SOCIAL SECURITY #:: BIRTHDATE:
CURRENT ADDRESS: City State Zip
PERMANENT ADDRESS:
TELEPHONE: (Home)    (Work)
E-MAIL ADDRESS:
AGE RANGE: 14-18       19-28     29-40       Over 64
EDUCATION: High School     BS/BA   MS/MA   Other (Specify)
FIELD OF STUDY:
OCCUPATION:
EMPLOYER:
Do you have experience working with Children special needs? Yes   No
Describe:
How did you hear about our program?
Please Indicate the grade level you would prefer to work with (check as many as apply):
 1-3       4-5       6-8       9-10      11-12
Please indicate the match level that you feel comfortable tutoring (check as many as apply):
 Elementary (K-6)  Middle school (geometry)  High School (algebra) Advanced (calculs)

Preferred site(s) to tutor:
 CentriNía (Sat 10-12)                                       CentroNía (Wed 5-7)
 Bruce Monroe (Mon & Wed 3:30-5:30)              Powell (Tues & Thurs 3:30-5:30)
 Brightwood (Mon & Wed 3:30-5:30)                  San Miguel (Tues & Thurs 3:30-5:30)

Emergency Contact: Phone Number:

Inrterested in other volunteer opportunities within the Family Literacy Program or within
CentroNía?   if Yes, please see Family Literacy Coordinator.

                     *See enclosed package for training dates for Reading and Match*