VOLUNTEER APPLICATION

 

General Information

Today's Date:

Name - last: first:

           

Street Address:

City, Zip Code:

Home Phone: Work Phone: Cell/Pager:

Occupation  Employer:

E-mail:  Date of Birth: Gender:     Male    Female

Emergency Contact:    Relationship:

Emergency Contact Phone Number:

Race/Ethnicity (for statistical purposes only):

How did you hear about Back on Track?

Please select one below or if you heard about Back on Track from one of these other sources, please identify.

           School:           

                                                Friend/Relative:

                                                Other:  

                                                Volunteer Organization/Referral Service:

 

Tutoring Sites and Times: All tutors are expected to commit to one session per week through the end of the school year. Please enter your choice of tutoring session times in order of preference. Please consider a 3:30 time slot.

Third Baptist Church   1399 McAllister @ Pierce

First choice       

Second Choice

Third Choice   

 

Please check areas of interest for other volunteering opportunities with Back On Track:

  Special Events/Field Trips                                                            Computer/Technical Support

  Substitute Tutoring                                                                       Public Relations/Fundraising   

 

Experience

Do you have any prior volunteer experience?   Yes    No

If Yes, please describe (age, activities, responsibilities, etc.):

What talents/skills/interests do you bring to Back On Track?

What interests you most about volunteering at Back On Track?

What languages do you speak? (other than English)

  Beginner     Intermediate   Fluent    Native

  Beginner     Intermediate   Fluent    Native

 

Please check subjects you would feel comfortable tutoring:

  Basic Math (add, mult, fractions, etc.)

  Geometry

  Algebra I

  Advanced Algebra

  Reading

  Writing

  Elementary Science

  Biology

  Chemistry/Physics

  Social Studies

  English as a Second Language

  Foreign Language:

Please list two references:

Name  Relationship: Phone:

Name: Relationship: Phone:

 

Back On Track strives to protect the privacy of its participants. For convenience and scheduling purposes will you give permission to disclose your phone number to the parent/guardian of the student with whom you are matched?     Yes     No

 

If Yes, please specify which phone number to disclose (seleect one): Home Work   Other:

 

Thank you for considering being a tutor at Back On Track! Tell a friend!

 

Please return your completed application to:

 

Back On Track

1399 McAllister Street

San Francisco, CA 94115

Attn: Membership Coordinator