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The School District of
Volunteer
Application Return
the Completed Application to the school where you would like to volunteer
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Due to the nature of our
responsibility to our students and staff, all persons who interact with them
must be screened. Please complete
this application so that we have the information necessary to complete the
required background check and provide you with the best opportunities to
volunteer.
Returning
volunteers are not required to fill out a new
application.
Name (include maiden
name) :
_________________________________________________________________________________________
Home Address:
Home Email:
______________________________________________ Work Email:
_____________________________________________
Company: _____________________________________________ Phone (H) ______________________ (W)
_______________________
Birth date: _____/_____/ ______ Sex: Male Female Race: White Black Hispanic Other
Emergency
Contact
_________________________________________ Phone: (H) __________________ (W)
_____________________
What other states have you
lived in as an adult? __________________________________________________________________________
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Volunteer Preferences - Check all that apply! Is there a particular type of volunteer work in
which you are interested?
I am
most comfortable with: Reading
Writing
Math
Science
Social Studies
Music
Art
Physical Ed. I prefer
working with:
Pre-Kindergarten
Elementary
Middle School
High School
Adult Education Career Education
Days
Preferred:
Monday
Tuesday
Wednesday
Thursday
Friday Hours
Preferred:
AM PM
Evenings School I’d like to work with:
____________________________________________________________________ |
Skills and Interests -
Please tell us a little about yourself.
Educational
Background:
__________________________________________________________________________________
Hobbies, Interest,
Skills:
___________________________________________________________________________________
Languages spoken other than
English:
________________________________________________________________________
Previous Volunteer/Mentor
Experience:
_______________________________________________________________________
Civic/Community
Organizations:
_____________________________________________________________________________
Personal Reference --
Please list someone (not a relative) who has known you for at least one
year.
Name:
_______________________________________________ Phone: (H) ______________________(W)____________________
Address: ___________________________________________________________
City/Zip
___________________________________
Background
Check
In
order for The School District of Lee County to complete the processing volunteer
applications, I understand a routine local and state criminal background check
is conducted. Results will remain
confidential. I also understand and
agree to any background inquiries of agencies which maintain records of my past
activities. I authorize, without
reservation, any party or agency contacted to furnish the above-mentioned
information in accordance with all federal and state laws.
Signature ___________________________________________________________
Date: _________________
For assistance,
please contact Dr. Marie Dinon, 337-8356, mariesd@lee.k12.fl.us
Revised June
2007