Volunteer Application

DATE _________________ NAME ____________________________________________________

ADDRESS_____________________ STREET

_____________________________ APARTMENT/UNIT NUMBER

_____________________________ CITY

________ STATE

__________________ ZIP CODE

HOME PHONE ______________   HOURS _____________ WORK PHONE ______________   HOURS _____________ FAX ________________________   E-MAIL _____________ Name & Number of Someone Who Will Always Know How To Reach You: Name_______________________Phone___________ HOW DID YOU HEAR ABOUT READ/SAN DIEGO (Check all that apply): __ Another READ/San Diego Volunteer (Name________________) __ Church or Community Organization (Which One _____________) __ Co-Worker or Employer (Name _________________________) __ Family Member or Friends (Name ________________________) __ Government or Social Service Agency (Which One ___________) __ Internet/San Diego Public Library Home Page __ Library (Which One __________________________________) __ TV (What Station?______________________) __ Newspaper/Magazine (Which One?_______________________) __ Other (Source _______________________________________) __ Radio/TV Ads (What Station ____________________________) The following information will enable us to make more efficient matches of volunteer tutors and adult learners. Thank you for supplying this information; it will be kept confidential. Only your learner will know this information. You have the right not to provide this information; however, supplying this information makes the matching process easier and more effective. Gender: ___Male ___Female Birthdate: ______________________________________                Month                  Day                Year OR, In which age range do you fall? __16-19 __20-29 __30-39 __40-49 __50-59 __60-69 __70-79 __80+ Would you be willing to tutor a learner who smokes, realizing that smoking is not allowed in any READ/San Diego facility? (Circle)    Yes       No Which ethnic/racial group do you consider yourself to be? ____African Am. ____Am. Indian/Alaska Native ____Asian ____Latino ____Pacific Islander ____White ____Other (Specify__________________) EMPLOYMENT INFORMATION  (Please circle all that apply) Full-Time         Part-Time         Self-Employed         Unemployed           Disability         Retired    Public Assistance         Temporary Position OCCUPATION/JOB TITLE _____________________________________________________________________ CURRENT EMPLOYER  ____________________________________________________________________ ADDRESS  ____________________________________________________________________                            Street/City                                                 Zip Code Please list businesses or community groups who would be interested in our services.  Name of Business or Organization Contact Person             LANGUAGES What is your native language? _____________________________________________________ Native ability (Please circle):    Read       Speak       Write       Fluent Can you read, speak or write other languages?   Yes       No Which language(s? ______________________________________________________________ Other language ability (Please circle):       Read       Speak       Write       Fluent BACKGROUND INFORMATION Are you a court referred community service volunteer?        Yes       No If yes, please list the offense and number of hours required. ______________________ ____________________________________________________________________________ VOLUNTEER APPLICATION  - READ/San Diego                                                                                  -3- Please write one to two paragraphs on why you decided to volunteer for READ/San Diego. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ VOLUNTEER APPLICATION  - READ/San Diego                                                                                   -4- NAME: ___________________________________ MATCHING INFORMATION Please attach additional sheets if you wish to elaborate on any of the following questions. Do you have any plans which will interfere with matching you with an adult learner within the first two months after training?    Yes        No If “yes,” when are you available to start? Can you make a six-month to one year commitment?  (Mandatory minimum time for volunteer service is six months.)   Yes         No If “no,” why not? _______________________________________________________________ _______________________________________________________________ WHEN ARE YOU AVAILABLE FOR TUTORING? Please fill in hours of availability in the following grid:   MORNING AFTERNOON EVENING SUNDAY       MONDAY       TUESDAY       WEDNESDAY       THURSDAY       FRIDAY       SATURDAY       DUE TO THE LARGE NUMBER OF LEARNERS IN THE CENTRAL AREA, WOULD YOU BE WILLING TO TUTOR AT READ/SAN DIEGO? (5148 Market Street, approximately 5 miles east of Downtown San Diego, just off the Martin Luther King, Jr. Freeway [Highway 94 East.]) (Please Circle):     Yes        No What are the four branch libraries and/or learning centers closest to your home or work site? (See tutor training handbook..) 1.        _______________________________________________ 2.       _______________________________________________ 3.       _______________________________________________ 4.       _______________________________________________ Are there any special circumstances that you would like us to consider when matching you with an adult learner? __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ VOLUNTEER APPLICATION  - READ/San Diego                                                                         -5- NAME: ___________________________________                                                                                                         FLEXIBILITY IS EXTREMELY IMPORTANT IN THE MATCHING PROCESS.  WOULD YOU BE WILLING TO COMMUTE TO OTHER AREAS IN THE CITY OF SAN DIEGO? (Please circle):       Yes      No      If no, why not? _____________________________________________________ _____________________________________________________ _____________________________________________________ Mode of Transportation:     Car       Public Transit       None Student Preferences Age Group: ________________________________      _____ It Doesn't Matter Ethnicity: _________________________________       _____ It Doesn't Matter Gender: _____ Male Learner     _____ Female Learner     _____ It Doesn't Matter Program: _____ Literacy Learner (levels 0-8)    _____ Family Literacy Learner (levels 0-8) _____ ESL one-on-one    _____ ESL small group (2-3)    _____ ESL large group (4-5) Personal Preferences: ______________________________________________________ I am open to tutoring (check all that apply): _____ 1:to:1 at a branch library _____ 1:to:1 at a learning center. Which Ones? (Circle)            READ/San Diego (M-F)         Old Town (M & W am / afternoon)            Clairemont (M & Th pm)       Rancho Penasquitos (T & Th pm)            Hillcrest (M-F)                       St. Vincent De Paul Village (M-F) _____ an institutionalized learner: recovery, work furlough, homeless shelters _____ special learner at human service agency, i.e. teen pregnancy, women's center, etc. _____ exclusively mathematics (I have special skills and/or background in math) _____ a learner who is preparing for the GED high school equivalency diploma _____ a learn who is developmentally disabled _____ a learner, literacy, or ESL, who is preparing to become a U.S. citizen _____ any of the above (it does not matter... wherever I'm needed) VOLUNTEER APPLICATION  - READ/San Diego                                                                       -6- NAME: ___________________________________ What are your hobbies and interests? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Have you tutored or taught adult learners before? (Circle)    Yes     No If "yes," please explain: __________________________________________________________ __________________________________________________________ __________________________________________________________ What experiences have you had that might enhance tutoring? _________________________________________________________ _________________________________________________________ _________________________________________________________ Are you a member of any community group or service club? (Circle)                       Yes      No If "yes," which one(s)? _________________________________________________________ _________________________________________________________ _________________________________________________________ Please list previous or other current volunteer experiences: 1. _____________________________ 3. ________________________ 2. _____________________________ 4. ________________________ I am also interested in the following READ/San Diego volunteer opportunities (check all that apply) Training programs are available in all of the below areas (see job descriptions in handbook): ____ Assessment Counselor ____ Learning Center Manager ____ Office Assistant ____ Computer Lab Facilitator ____ Program Assistant ____ Data Entry Assistant ____ Library Materials Processor ____ Families for Literacy Program Assistant _________ Check here if you have decided not to tutor, but prefer to assist READ/San Diego and the literacy effort in another way. I would like to serve as:            ___________________________________________________________ Thank you. The Staff of READ/San Diego Click below for the READ/San Diego Fact Sheet Volunteer Application Tutor Training Schedule