LCBC Volunteer Application
Email address *
Name *
Date *
MM
/
DD
/
YYYY
Address *
City *
State *
Zip *
Home Phone *
Work Phone
Cell Phone
E-mail
Spouse's Name
How do you prefer LCBC to contact you? *
What is your birth date MM-DD-YYYY? *
MM
/
DD
/
YYYY
Are you 18 years or older? *
Gender *
Race (AR Dept of Ed requirement for statistics) *
Employed? *
If yes, where employed? *
Employment Type *
Area or Field of Work
Veteran? *
College Student? *
Special skills, hobbies, or interests
Education *
College degree if applicable?
Volunteer Days *
Required
Please put the ACTUAL time you are available
9 am, 3 pm, 6 pm, etc.
Morning
Afternoon
Evening
Student Preference *
Tutor Location Preference *
I could help with events or projects
I have other skills I could share
How did you hear about the Literacy Council of Benton County?
Why do you want to volunteer for the Literacy Council?
References: List below three persons not related to you, whom you have known at least one year
Name, Address, and Phone *
Name, Address, and Phone *
Name, Address, and Phone *
Have you ever been convicted of a felony? *
Emergency Contact
Name *
Relationship *
Address, City, State, Zip *
Home Phone *
Cell Phone
Work Phone
I understand that my services are voluntary and are a donation to Literacy Council of Benton County, Inc. and to its adult students. *
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