HOMEWORK HELP CENTER VOLUNTEER APPLICATION
GRINNELL LIBRARY
2642 East Main Street, Wappingers Falls NY 12590
P:(845) 297-3428 F:(845)297-1506
http://Grinnell-Library.org
Name:___________________________________________________________
Age:_____________ School: _____________________________________ Grade: ____________
Address:___________________________________________________________________________
Phone (Home):______________ Phone (Mobile):_________________ Email:______________________
Current Classes with Grade Range (Below 65, 65-75, 75-85, 85-90, 90+)
_____________________ _____________________ ____________________ _________________
_____________________ _____________________ _____________________ _________________
Academic Reference
Name:_____________________________________ Relation:____________________________
Phone:_____________________ Email:__________________________________
Have you had experience tutoring before? Yes No
If yes, please briefly describe ______________________________________________________
Grinnell Library Homework Help Center is open Monday – Thursday from 4:30 to 8:30 PM
Which days are you available to help? Monday Tuesday Wednesday Thursday
Reason for Volunteering: _______________________________________________________________
Do you need proof of volunteering? Yes No
If yes, explain: ___________________________________________________________________
Emergency Contact:
Name: _________________________________ Relation: ______________________________
Phone: _________________________________
_______________________________________________________ _____________________
Volunteer’s Signature Date
I give permission for my son/daughter to volunteer at Grinnell Library. I understand that my child should be picked up promptly (if necessary) when his/her volunteer time is over and that he/she will be expected to dress appropriately for work in a public place.
________________________________ _________________________________ ______________
Parent/Guardian Name (print) Parent/Guardian Signature Date
