Volunteer Application

Name:                                             (Last)                                                            (First)
Address:
E-Mail:
Telephone:
Age:
Your High School, College, or Affiliate Organization
How did you hear about Learning Center? 

Dates of Service: Hours Available: Starting: Ending: AM: PM: Indicate your area(s) of volunteer interest:   Early Childhood Education  Administrative  Technology  School Age Department  Tutoring Program  Homework Help   Educational Background Check all that apply:  Some High School  High School Diploma  If currently enrolled in college  BS/BA  MS/MA

Person to contact in case of an emergency:                                                              
Name
Relation
Phone Number
If you are under the age of 18, please have legal guardian sign consent:

Signature

Please Print Name

OFFICE USE ONLY Group assigned: Schedule:  CentroNía Orientation   TB/Health physical forms  Police clearance form (over the age 18) Volunteer’s signature or parent signature on file