You Will Be Placed Pending a Background Check

Seacoast Reads Volunteer Application Form

**Please print clearly**

You will be placed pending a Background Check

and the reference checks you provided

newor returning (circle) # of semesters:______

Name: ______UNH ID number: ______

Local address: ______

Home address (permanent): ______

Phone: ______E-mail (print clearly): ______

***Please be sure to provide us with a current email address you check regularly***

Year in School: ______Major: ______Graduation Date: (month/year): ______

Are you a student athlete?Y or NSport: ______

Would you be willing to drive other volunteers in your insured vehicle? Y or N If so, how many?______

***If you are willing to be a carpool driver you can receive up to $100 back for gas money***

Would you be willing to be a Site Coordinator? Must be a returning tutor.Y or N

Site Coordinators are the main contact between tutors and the site professional located at your site. You would be in charge of a small amount of paperwork and managing any schedule changes.

Put a ✔in the time blocks you are available throughout the week. Times include travel to and from campus. If you have a commitment just before or after the time selected please write that in so we can account for travel pickup and drop offs.Please contact us immediately if anything changes. Thanks!

Do you have a preference for a particular site placement? Please list below.

______
Training Dates Choose One date and time you are available. ALL TUTORS SELECT ONE.

Date 1: Tues. Sep. 26, 5:10-6:30pm Date 2:Thurs. Sep. 28, 5:10-6:30pm

Grade Level Please indicate the grade level you would prefer to work with. K-4 or 5-9 or No preference

ReferencesNEW TUTORS ONLY. Please provide two professional references (e.g., former employers, hall directors, professors, etc.). Please do not list roommates, family members, or friends.

1. ______

NamePhone #Relationship to you

______

Company nameAddressEmail (required)

2. ______

NamePhone #Relationship to you

______

Company nameAddressEmail (required)

Personal StatementNEW TUTORS ONLY. Why are you interested in working with Seacoast Reads? List some personal experiences, skills, educational training, and/or community activities that tell us about yourself (attach an additional sheet if necessary).

______

______

______

______

______

______

______

How did you hear about us? ______

Background Information (circle yes or no).

• I am in good standing with the university and agree to permit Seacoast Reads to

verify this through my academic and judicial records.yesno

• I am willing to provide documentation of automobile liability coverage if applicable.yesno
• I am willing to submit to a police background check if required.yesno