1. Tell us something about yourself:

Full Name: *

Address: *

City: *

State: *

Zip: *

Home Phone: *

Work Phone

Fax

E-mail: *

Date of Birth *

SS Number:

4. Education

Please include school name, city and state for high schools and colleges attended.

5. Which of the following activities interests you?

Tutoring/Homework Help

Mentoring

Chaperoning Activities/Outings

Fundraising/Special Events/Grant Writing

Office Help/Typing/Filing/Data Entry

Volunteer Coordination

Computer Lab

Board or Committee Membership

Translating Documents

6. What age of students are you interested in working with?

PreSchool

Elementary School

Middle School

High School

Adults

8. If you chose "Mentoring" in question 5, please answer the next two questions

a. Please describe the skills, interests, hobbies, and similar characteristics that you are willing and able to share with a child

If you know more specifically, write the times you are available.
Adult program hours are Weekdays 8:00 am to 9:00 pm and on Saturday mornings.
School age program hours (Elementary, middle, and highschool) are
Weekdays 3:00 pm to 5:30 pm.
PreSchool program hours are Weekdays 7:00 am to 4:30 pm.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

11. What qualities or characteristics do you think are important when working with youth/young adults?

12. What personal experiences have you had that you feel would be particularly helpful in your volunteer work at The Family Learning Center?

13. Are you a U.S. citizen?

Yes No

14. If not, do you have a green card?

Yes No

15. Have you ever been involved, arrested or convicted of a criminal offense?

Yes No

16. Have you ever been the subject of a child abuse investigation?

Yes No

17. How did you find out about The Family Learning Center of Boulder County?

18. Please list references (preferably local) you have known for two years.

Mentors should list three references and all other volunteers should list two.

Reference 1

Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Fax number:

Relationship to you:

Reference 2

Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Fax number:

Relationship to you:

Reference 3

Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Fax number:

Relationship to you:

Transporting Children in your car is required for mentors, and optional for tutors and other volunteers. If you are interesting in becoming a mentor, or are willing to use your personal vehicle and insurance in transporting children to and from tutoring and other activities, please complete the following information:

Do you have at least the required minimum liability insurance on your vehicle?

Yes No

Driver's license number and state (not your car license plates):

You will need to provide a copy of your driver's license and insurance verification.

By clicking the Send button below to submit this volunteer application, you authorize the release of your criminal history and records to the Family Learning Center through the Central Registry, motor vehicle records, police background check and reference checks.

It may take a few minutes to submit the form. Please wait for a "Thank You" message to appear. Otherwise the information will not be received. Please be patience.

3164 34th Street, Boulder, Colorado 80301
(303)442-8979 Fax (303)442-0901
Email address: info@flcboulder.org

Volunteer Application

1. Tell us something about yourself:

2. Most Recent Work History

3. Most Recent Volunteer Work History

4. Education

5. Which of the following activities interests you?

6. What age of students are you interested in working with?

7. If you chose "Tutoring/homework Help in Section 5, what subjects are you most comfortable teaching?

8. If you chose "Mentoring" in question 5, please answer the next two questions

9. How many hours can you volunteer per week?

10. What specific days of the week and times are you available?

11. What qualities or characteristics do you think are important when working with youth/young adults?

12. What personal experiences have you had that you feel would be particularly helpful in your volunteer work at The Family Learning Center?

13. Are you a U.S. citizen?

14. If not, do you have a green card?

15. Have you ever been involved, arrested or convicted of a criminal offense?

16. Have you ever been the subject of a child abuse investigation?

17. How did you find out about The Family Learning Center of Boulder County?

18. Please list references (preferably local) you have known for two years.

Reference 1

Reference 2

Reference 3

19. Please write anything else that would be helpful for us to know about you:

20. Are you able to transport youth in your automobile for off-site activities?