Application « Stiles Hall

Name*

FirstLast

Date of Birth

Local Address

Street AddressAddress Line 2CityStateZip Code

Email*

Phone*

Race / Ethnicity

Gender

Language(s) Spoken

Student ID #

Major

Current No. of Units

GPA

0.0 to 5.0

Are you eligible for Work Study?

Best Time To Reach You

: HH

MM

Community Service Projects

What is your first choice project?

If your first choice is not available, are there other projects you would consider?

Mentoring
Tutoring
Elderly Companionship
Sports 4 Kids

What grade levels would you prefer to work wth?

What ethnicity would you prefer to work with?

Preferred School Site (if any)

Coordinator

Safety Information

Do you own a car?

Drivers License No.

Issuing State

Insurance Carrier

Insurance Policy No.

Have you ever been convicted of a felony?*

Fingerprint clearance after acceptance into program is required prior to spending any unsupervised time with a child you will tutor/mentor.

Tell Us About Yourself

Why are you interested in this program?

What would you consider to be your strengths and weaknesses?

Please tell us about any other relevant community service experience you have.

Please explain any extracurricular or 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.*

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Community Service Projects

Safety Information

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