Tutor Sign Up BUDDHA BLESSED TEMPLE 7748 3rd Street RoadLouisville, KY 40214 Phone: (832) 863-1861Email: email@example.com VOLUNTEER APPLICATION (* is a required field) Last Name * First Name * Middle Initial Age * Address 1 City * State * ... AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone * Email * Driver License Number Emergency Contact Information Name * Relationship * ... AuntBrotherBrother-in-lawCousinDaughterFatherFather-in-lawGranddaughterGrandfatherGrandmotherGrandsonHusbandLegal guardianMotherMother-in-lawNephewNieceSisterSister-in-lawSonStep-daughterStep-fatherStep-motherStep-sonUncleWife Phone * Email Skills and Education Middle School 6 7 8 High School 9 10 11 12 College 1 2 3 4 Graduate * 1 2 3 4 Major Name of School Are you able to communicate in a language other than English? Yes No If yes, which language: Are you currently employed? Yes No If yes, please give your place of employment and position (This will not affect your ability to volunteer): Will you be the SAT/ACT Prep. tutor? Yes No Please specify the subject(s) that you comfort to tutor: * Elementary School Math English Science Middle School Math English Science High School Algebra 1 Geometry Algebra 2 Precalculus/Trigonometry Calculus Please specify the grade level that you comfort to tutor: * Volunteering Experience Hours to teach per week * Year(s) of teaching experience Prefer to help research & organize the subjects Prefer to help in recruiting new tutors and students Please list relevant work and/or volunteering experience (including dates of services): Please explain why you like to work with children: Please explain why you want to be a volunteer at this center: Please explain how you learned about our After-School Program? Availability (select all that apply): * Monday 5:00-7:00 PM Tuesday 5:00-7:00 PM Wednesday 5:00-7:00 PM Thursday 5:00-7:00 PM *Have you ever been convicted of a serious crime/felony other than a traffic violation? Yes No If yes, this application will be void and invalid. Please list any physical limitations, restrictions or other areas of concern (this will not affect your ability to volunteer): Please list two references of people who know you well, preferably for whom you have worked in either a paid or volunteer capacity. If you are currently working, either paid or as a volunteer, please include the name of your supervisor. Name Phone Relationship 1. ... AuntBrotherBrother-in-lawCousinDaughterFatherFather-in-lawGranddaughterGrandfatherGrandmotherGrandsonHusbandLegal guardianMotherMother-in-lawNephewNieceSisterSister-in-lawSonStep-daughterStep-fatherStep-motherStep-sonUncleWife 2. ... AuntBrotherBrother-in-lawCousinDaughterFatherFather-in-lawGranddaughterGrandfatherGrandmotherGrandsonHusbandLegal guardianMotherMother-in-lawNephewNieceSisterSister-in-lawSonStep-daughterStep-fatherStep-motherStep-sonUncleWife After School Program Volunteer Contract I agree to: Volunteer at the Online Tutoring Center for at least two hours per week for at least one semester. Go to the Online Tutoring Center to tutor according to my designated schedule. Go to the Online Tutoring Center to tutor according to my designated schedule. Follow the Online Tutoring Center’s goals and missions at all times. Devote and perform my volunteer responsibilities wholehearted to all students at the Online Tutoring Center. Be helpful and respectful to everyone at the Online Tutoring Center. Discuss my needs with the staffs and share my experiences as a volunteer. Think, act, and talk in a role model manner. Motivate students to achieve their educational goals. Maintain a professional approach with the Center’s members and its students. Protect the confidentiality of all students’ and members’ privacy even their personal information had been revealed by others by not sharing that information with the unauthorized and non-members or any social agency Follow the state law to report any child who I suspect to be a victim of child abuse. Respect and return any Center’s trademarked and copyrighted materials, program, property, and publication after using them. I have read and fully understand this agreement. By summitting this application, I affirm that the above information are true. I completely acknowledge that if I make any false statement or misrepresentation on this application, even after being accepted as a volunteer after school tutor, I may be immediately dismissal. Note: Buddha Blessed Temple reserves the right to decline a volunteer applicant for any reason at any time. Examples of a crime/felony include: murder, manslaughter, vehicular homicide, tax evasion, arson, or others. If you are under 18 years old, your parents should fill out and sign a parental consent form. Thank you for your interest in volunteering for this Online After-School Program.