HOMEWORK HELP CENTER VOLUNTEER APPLICATION

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