Volunteer Application

Personal Information
Name
Date
Address
Home Phone
City, State, Zip
Cell Phone
Employer
Work Phone
Email
Emergency Contact Person
Emergency Contact Phone
How did you hear about us? TV___   Newspaper___   Friend___
Highest Grade Completed
Course of Study
Other languages spoken
For statistical purposes only (voluntary information
Sex    Female___    Male___                                                                                                                                     Birthday
Marital status                                                                                                                                                             Race

How would you like to volunteer?

Tutoring (min. committment 9 months)  ___                                                                                                              General office work (min. committment 1 month)  ___ 
Board Member/Committee ( min. committment 18 months)  ___                                                                                Fund raising (min. committment 12 months)  ___
Donation  ___                                                                                                                                                            Other  ___

Check your preferred tutoring subject:
Reading  ___  Writing  ___  Grammar  ___  Math  ___  ESL  ___  Other  ___

Check  your preferred student type:
child 6-12  ___  adult 19 +  ___  Teen 13-18  ___  male  ___  female  ___  no pref.  ___
Check your preferred skill level:
beginning  ___  elementary  ___  intermediate  ___  advanced  ___

Availability:


References: (non-relative)
Name
Name
Address
Address
City, State, Zip
City, State, Zip
Telephone
Telephone

Notice to all applicants: The Literacy Council of Sumner County reserves th e right to conduct background checks on all applicants.
This document and all other applicable forms ill be secured and filed according to LCSC Board of Directors published guidelines.

For Office Use Only:
Orientation:		Initial:

Student(s)/Matched:



FAT City Training:

Beacon:
Date observed:
Mentor:
Terminated:
Awards:
Reopened:
Workshop:
File closed:
Other:
Other training:


VOLUNTEER CONFIDENTIALITY AGREEMENT
Volunteer agrees that any and all knowledge or information that may be obtained with respect to the conduct and details of the organization and with respect to the conduct and details of the organization and with respect to its clients and services will be forever held inviolate and be concealed from any and all other persons and that he or she will not impart the knowledge acquired to any other person or other organization.

WAIVER AND RELEASE FOR VOLUNTEERS
In consideration of my being allowed to be involved in the literacy program sponsored by the Literacy Council of Sumner County (LCSC), I hereby agree to release and forever discharge the LCSC and all its volunteers, employees, officials, directors and agents, for any and all claims, demands, actions and lawsuits for injuries and expenses sustained and/or incurred to my person and/or property as a result of my involvement with LCSC. I understand that as a volunteer my activities may involve physical activity, contact with unidentified and unfamiliar persons, travel, and other potential risks of injury to me and my property, and I hereby assume all such risks.


Signature____________________________________                 Print Name___________________________________



Witnessed by ________________________________                  Address______________________________________



                                                                                                        City, State, Zip_____________________________


Parent or Guardian (if minor)  _____________________________________________


Date_________________________________________



VOLUNTEER TUTOR AGREEMENT

As a volunteer I agree to:
1.Tutor an adult or child at least___hours a week for a minimum of ___weeks.
2. Prepare adequately in advance for each lesson using LCSC and other materials.
3. Inform the student in advance if a lesson must be missed or rescheduled.
4. Notify LCSC at least 2 weeks in advance of terminating tutoring services.
5. Attend required LCSC training workshops.
6. Complete and submit monthly volunteer time sheets.

In return, LCSC agrees to:
1. Provide training, materials, and confidential support.
2. Sponsor training workshops twice a year.
3. Contact the tutor monthly to discuss student progress, provide information about materials and lesson preparation, answer questions, and record hours volunteered.
4. Encourage volunteer input and suggestions with regard to student's instructional plans and general tutoring operation.

LCSC Board of Directors does not approve of:
1. Meeting in a home or other non-public location.
2. Allowing tutor or student to provide transportation for tutoring session.
3. Conduction tutoring session of a minor without parental (or guardian) supervision.




Signature_____________________________________               Date__________________________________________