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Volunteer Tutor Application Form

Application Date
Name
Street Address
City, State, Zip Code
Gender
Male
Female
 
Phone
Home
Work
Cell
Email Address
Date of Birth
Emergency Contact
What is the best way to contact you?
Phone
Email
 
Place of Birth
What Languages
Do You Speak?
Hobbies & Interests
Previous
Volunteer
Experiences:
Tutoring adults is a rewarding and challenging experience. Why do you want to volunteer with Literacy volunteers?
Literacy Volunteers asks that you remain active in the program for at least one (1) year after you have been trained and that you spend at least 2 hours per week tutoring the student(s) assigned to you. Will this be possible for you? Yes No  
Are you interested inparticipating in fundraising efforts throughout the year? Yes No  
Ethnic Group Native American Hispanic White
Black Asian/Pacific Islander Other
Employment Status Full Time Part Time  
Unemployed Retired Seeking Employment
Name of Current
or Last Employer
Title or Position
Education High School Some College  
College Degree Graduate Degree
Area of Specialty
Referral Source TV Program or Ad Library Public Relations
Radio Website Phone Book
Newspaper Special Event Current LV Tutor
Employer Volunteer Center Another Agency
Friend/Family Poster/Flyer Other
Please Indicate the Type of Tutoring You Are Interested In Basic Literacy
(English speaking students learning to read and write) 		No Preference
ESOL
(English for Speakers of Other Languages) 		Undecided
Please Indicate the Times and Days You Are Available to Tutor Mornings Days:
Afternoons Days:
Evenings Days:
Weekends

Please Indicate Where You Would Prefer to Tutor

I am interested in tutoring in the Greater New Haven area

I am interested in tutoring in the Meriden/Wallingford area

I am interested in tutoring in the Valley

Literacy Volunteers of Greater New Haven will accept volunteers without regard to age, gender, color, national origin, religion, disability, political belief, sexual orientation, familial or veteran status.

Looking for Resources?

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NEW HAVEN OFFICE: 4 Science Park, New Haven, CT 06511
p: 203-776-5899 • f: 203-865-3867 • e: info@lvagnh.org

MERIDEN OFFICE: 14 West Main Street, Meriden, CT 06451
p: 203-235-1714 • f: 203-440-3138 • e: info@lvagnh.org

VALLEY OFFICE: Valley Regional Adult Education, 415 Howe Avenue, Shelton, CT 06484
p: 203-924-6651 • e: info@lvagnh.org

Copyright © 2012 Literacy Volunteers of Greater New Haven

 

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