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Summer 2019 BTM Carrollton Volunteer Interest Form
Get ready to make an impact on the future. Volunteers are vital to the success of our program. Our summer institute operates Monday through Friday, June 10th - August 2nd. Please complete this form and email the following to

1. Copy of report card or transcripts
2. High school students: Letter of good standing from school administrator (print and complete):
College students: Letter of recommendation
3. Volunteer enrollment packet (UNDER 18 years old; please print and complete):

Volunteer enrollment packet (18 and OVER; please print and complete):

A Breakthrough Miami site staff member from Carrollton will contact you with information regarding next steps.

First Name *
Last Name *
I identify my gender as *
Different identity (please state)
Birth Date (MM/DD/YYYY) *
Email Address *
Cell Phone *
Name of school you currently attend? *
Education level (Current status) *
Classification *
Have you previously volunteered at a Breakthrough? *
If you answered yes, which site? What was your role?
Our summer program operates from June 10th - August 2nd. Please indicate when you are available to volunteer:
Week of June 10th
Week of June 17th
Week of June 24th
Week of July 1st
Week of July 8th
Week of July 15th
Week of July 22nd
Week of July 29th
Please indicate the times you are available to volunteer *
What form of volunteering would you prefer to do? *
Briefly tell us about your past volunteer experiences and any involvement in school clubs, activities, etc.
How did you hear about us? *
Have you ever been convicted of, or is any charge now pending or expected to be brought against you for any crime other than a minor traffic violation? *
Have you ever been in anything other than good standing at an academic institution because of academic deficiencies, misconduct, and/or have you been the subject of disciplinary proceedings? *
Additional information you would like to provide for Site Director(s):
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