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PROJECT READ: Volunteer Tutor Interest Form
Leave This Blank:
First & Last Name:
Mailing Address:
City:
Zip:
State:
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Home or Cell Phone:
Work Phone:
Can we contact you at work?
Yes
No
Email Address:
Preferred Method of Contact:
Home or Cell Phone
Work Phone
Email Address
I am:
Male
Female
Date of Birth:
Library Card #:
Ethnicity:
Asian
Black
Hispanic/Latino
Native American
Pacific Islander
White
Other
Education (highest level completed):
Employment Status:
Employed FT
Employed PT
Unemployed
Retired
Disabled
Self-employed
Unknown
Job Title:
Employer:
What is your native language?
Please list any other languages spoken:
Where did you hear about Project Read?
Why does Project Read interest you?
Can you tutor twice each week?
(60-90 minutes each session)
Please list the days and times you are available to tutor:
Please list any special skills, interests, hobbies, or experiences:
Have you had any experience in the teaching or tutoring of adults? Please describe:
Please list any community groups that you belong to:
Have you volunteered before? If so, where and doing what type of work?
In addition to tutoring, would you be willing to donate your skills to Project Read in other ways?
speaking to community groups
distributing Project Read brochures in the community
fundraising
computer work
helping out in the office
Please describe any other skills you might like to contribute:
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