Volunteer Name:* Date:

Address:*

City:*

State:* Zip Code:*

Home Phone number:*

Cell Phone number:*

School:*

Date of Birth:*

Are you currently volunteering? No Yes

If Yes, Are you happy with your assignment(s)? No Yes

Please check all activities that interest you:*

Read with a student
One-on-One mentor
Assist in Math
Work with children with special needs
One-on-one tutoring
Assist in Science
Help students with motor skill problems
Help with Arts and Crafts
Help students use library resources
Discuss careers or training opportunities
Assist non-English speaking students expanding their vocabulary
Help in Computer Lab
Assist in Fine Arts
Assist students in writing
Play musical instruments
Help with homework
Be a pen pal
Assist teacher with a variety of classroom task
Other

When are you available?*
Monday Tuesday Wednesday Thursday Friday

Please check all ages you would like to work with:*
Kindergarten-2nd grade
3rd-4th grade
5th-6th grade
7th-8th grade

If you have a teacher preference please list his/her name:
(Separate each other with comma)