Stiles Hall

Community Service Application

General Information
First Name: Last Name: Date of Birth:
Local Address: Phone No.
Email Address: 2nd Phone No.
Permanent Address: Phone No.
Race/Ethnicity: Sex: Language(s) you speak:

SID No: Major: Year in School
Current No. of Units: GPA: Work Study eligible:

Safety Information
Do you have a car? Driver's License No: Insurance Co.
Insurance Policy#:
Have you ever been convicted of a felony?
*Fingerprint clearance (after acceptance into program) is required prior to any unsupervised time spent with a child you will tutor/mentor

Community Service Projects
Please number project(s) to which you are applying according to preference (1st, 2nd, etc.)
First Preference: Second Preference: Third Preference:
Which grade levels would you prefer to work with?:
Which ethnicity would you prefer to work with?:
School Site: Coordinator:
Best time to reach you by phone:

Questions
Why are you interested in this program?

What would you consider your strengths/weaknesses?

Past community service experience, explain?

Extracurricular and job commitments?

By typing in your full name below you agree to the following:
The information that I have provided is to the best of my knowledge and belief, true, correct and complete. I agree to release Stiles Hall from all liability, claims and loss or damage arising out of my participation in this volunteer service and only to use a properly insured vehicle for all Stiles Hall transport.

Full Name:


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