San Mateo, CA - Official Website

First & Last Name:

Mailing Address:

City:

Zip:

State:

Home or Cell Phone:

Work Phone:

Can we contact you at work?

Yes

No

Email Address:

Preferred Method of Contact:

I am:

Male

Female

Date of Birth:

Library Card #:

Ethnicity:

Education (highest level completed):

Employment Status:

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: