Volunteer Application Form - ConnectAble - Adult Education solutions from enrollment to employment

Click here to download a PDF copy of the application.

First Name

Last Name

Phone Number

Gender

Male

Female

Other

Date of Birth.

Age

Current Address:

Please provide a full 7-year address history. If you have not lived at your current address for the entire 7 years, use the Additional Address section to list previous addresses until the full 7-year history is complete.

Street Address

City

State

Zip Code

Date Started Living at this Address

Race/ethnicity. Select all that apply.

Hispanic

Black/African American

Asian

Native American

White

Multiple Ethnicities

Other

I prefer not to answer.

Other Race/ethnicity

Employment Information:

Currently Employed?

Yes

Education

Highest level achieved

If college, please indicate area of study or emphasis (i.e. business, teaching, etc.):

Volunteer:

Do you want to tutor: In-person, Virtual, Both?

In-person

Virtual

Both

Please indicate which days of the week you are available and whether you are available in the morning, afternoon, or evening.

How soon do you wish to begin tutoring?

Is there any time of year that you are not available?

Languages:

Are you fluent in any other languages?

Note: You do not need to be bilingual to volunteer.

Do you require any accommodations?

Yes

How did you learn about our program?

Emergency Contact Information:

Emergency Contact Person

Relationship

Emergency Contact Phone

VOLUNTEER RESPONSIBILITIES & POLICIES

A. PURPOSE: The role of a volunteer is to provide literacy, administrative, or other support to adult students and staff.

B. QUALIFICATIONS / RESPONSIBILITIES

All volunteers must:

Be the minimum age of 18 years old (Tutor). Age of other volunteer positions at discretion of Director.
Be a high school graduate or equivalent.
Demonstrate the ability to read, write, and speak English to communicate effectively.
Demonstrate a sincere interest in providing support to adult students with diverse backgrounds.
Demonstrate the ability to be sensitive to and respectful of the cultural, ethnic and socio-economic diversity of students, staff and other volunteers.
Demonstrate the ability to work with and maintain confidential relationships.
Work to ensure that all WCLC settings are free from political and/or religious influence or bias.
Agree to volunteer for a one year commitment, and if unable to complete volunteer term of service, will notify WCLC 30 days in advance of tutoring end date.
Submit to and pass the Board approved background check.

C. POLICIES

BACKGROUND CHECK

It is the policy of the Walworth County Literacy Board to conduct background checks on all volunteers. By signing below, the volunteer gives permission for the Council to conduct a background check.

TUTORING LOCATION POLICY

It is the policy of the Walworth County Literacy Council to prohibit tutoring at sites other than those approved by the Instructional Specialist. This prohibition includes home tutoring.
Online tutoring must be approved by the Instructional Support Specialist.
Online tutoring outside of Walworth County, for a temporary amount of time, will be reviewed and approved by the Executive Director.

TRANSPORTATION POLICY

Transportation of a student by a volunteer in a vehicle or transportation of a volunteer by a student in a vehicle for any activity directly and indirectly related to the WCLC is prohibited.

VOLUNTEER DISMISSAL POLICY

A volunteer may be dismissed for misrepresenting his/her qualifications and/or not completing training, not complying with stated responsibilities, disregarding policies demonstrated by behavior that is incompatible with the mission of the WCLC as established by the Board of Directors.

Any volunteer who is under the influence of or possesses alcohol or illegal drugs on the program premises during volunteer activity will be dismissed from the program.
Complaints or grievances regarding volunteers must be presented in writing to the Director.
The volunteer will meet with the Director to discuss the alleged infraction(s).
If this complaint is not remedied, a written plan (compliance plan) will be developed by the Director and the volunteer. If the infraction continues after the date of compliance, the Director will recommend dismissal.
If the dismissal is contested by the volunteer, the matter shall be appealed to the WCLC Board for the final decision.
Should a volunteer have a disagreement with the Director, a complaint may be filed with the Board.

*This requirement may be waived at the Director’s discretion.

APPLICANT CONSENT

I have read and understand the above requirements, responsibilities and policies, and I agree to comply with them and to submit to a background check. I understand that I am a volunteer for the Walworth County Literacy Council and receive no compensation for my services. I further understand that I may stop volunteering at any time for any reason, and the Walworth County Literacy Council can stop using my volunteer service at any time for any reason.

Signature:

Date:

MEDIA CONSENT

WALWORTH COUNTY LITERACY COUNCIL has my permission to use photographs, video, or audio of myself, my name and literacy story in printed materials (including, but not limited to, newsletters, books, brochures, promotional and/or informational materials) and electronic media (including, but not limited to, video, audio, websites, and social media).

Yes

Please upload a favorite photo of yourself so that we can use it for your profile.

Please include only your head and shoulders in the image.

A copy of this signed agreement will be kept in the volunteer file and provided to volunteer upon request.

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