Communities in Schools of Tacoma

VOLUNTEER APPLICATION FORM Read Across America Day March 2nd 2017 Thank you for your interest in volunteering with Communities In Schools of Tacoma! By completing this application form, you are applying to be a registered volunteer with Communities In Schools of Tacoma. Please complete front and back of this form and return to a volunteer coordinator with a color copy of your ID. All potential volunteers must complete a Washington State Patrol Background Check. Volunteer Coordinators: April Shine [email protected] or Valerie Sweisthal [email protected]

Please type or print clearly

Name: ______(Last Name) (First Name) (Middle Initial)

Address: ______City: ______State:______Zip: ______

Phone Number: ______(Home) (Work)

E-mail Address: ______Date of Birth: ______(Month) (Day) (Year) Emergency Contact: ______Phone Number: ______

Relationship: ______

Please check the school site(s) at which you are interested in volunteering:

___Arlington Elementary ___Sheridan Elementary ___Fern Hill Elementary ___Sherman Elementary ___Mc Carver Elementary ___Whitman Elementary

Availability on March 2, 2017 (Read Across America Day):

___9:15am-10am ___10am-10:45am ___1:15pm-2:15pm

If you are fluent in any language other than English, please indicate below:

Language: ______Speak/Understand ____ Read ___ Write

D:\Docs\2017-12-14\033cf391355b1812bc7dd728f9fb6321.doc Volunteer History:

If you have volunteered before, please give details of where you have volunteered, for how long, and describe your volunteer role.

Please tell us about any educational background, work, or volunteering experience that would be relevant to the volunteer role you are applying for.

Please list any hobbies, skills, special interests, or qualities you may have that would be relevant to the volunteer role you are applying for.

Have you ever pled guilty, been convicted, fined, imprisoned, or placed on probation for violation of any law, police regulation, or ordinance, excluding minor traffic violations?

_____ Yes _____ No If yes, please explain:

______

Provide 2 references of individuals whom you have worked or volunteered for in the past 5 years:

1) Name of Organization or Business: ______Contact Name:______Title:______Phone:______2) Name of Organization or Business: ______Contact Name:______Title:______Phone:______

Authority to release information : I certify that any and all statements made on this application and any attached papers are true and complete to the best of my knowledge. I understand that the information on this application may be subject to investigation and verification and that any misrepresentation or material omission may cause my application to be rejected or terminated immediately.

I HAVE READ THE STATEMENTS ABOVE CAREFULLY BEFORE SIGNING THIS APPLICATION:

______Signature Date

Photo Release Consent: I hereby give my consent to Communities In Schools of Tacoma to use any photographs that may be taken of me while participating as a volunteer.

______Signature Date

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