SYP 18-19 BTM Gulliver Volunteer Interest Form
Our school year program operates TWO Saturdays a month and every Tuesday between OCTOBER 2018 and APRIL 2019. Please complete this form and the Breakthrough site staff at Gulliver will contact you within a week with information regarding the following: volunteer orientation and volunteer work schedule. Thank you for your interest in serving with Breakthrough Miami!

Please note: If you are a Breakthrough Scholar, you must be a minimum of a Junior in high school to be eligible to volunteer during the school year. Non-Breakthrough Scholars are eligible to volunteer as early as Freshman year.

In addition to the Volunteer Interest Form, all volunteers must complete the following before being permitted to begin serving with Breakthrough Miami:

1. Volunteer Enrollment Packet
Volunteers should sign and date the form.

2. Letter of Good Standing
Volunteers under 18 years of age need to sign and date this form, and have a school administrator sign and date it, as well.

3. Current Report Card with Conduct Grades (Transcript for College Students)
Volunteers should print recent report of Academic and Conduct grades.

4. Resume
Volunteers should construct a resume reflecting their professional accomplishments, including, but not limited to club affiliations, participation in sports, community engagement, and academic achievements.

5. Fingerprint Technologies/Drug-Screening
Volunteers 18 years of age and older, who are working directly with Scholars, will need to be have their fingerprints and drug-screening completed through Gulliver Schools service-provider.

Volunteers who are UNDER 18 years of age please PRINT and COMPLETE the following:
https://drive.google.com/a/breakthroughmiami.org/file/d/0B9Om6tsXvHDgY0xSM2JVV0w1VzQ/view?usp=sharing

Volunteers who are OVER 18 years of age please PRINT and COMPLETE the following:
https://drive.google.com/file/d/1do8VWju4cfUQB5M00MowZ5VWctYq3HJz/view?usp=sharing

ALL VOLUNTEERS MUST COMPLETE THE FOLLOWING WEBINAR TRAINING AND RECEIVE A PASSING SCORE ABOVE 70% BEFORE THEY WILL BE ALLOWED TO BEGIN SERVING: https://www.playposit.com/listcode/660993/u6e16d

Last Name *
Your answer
First Name *
Your answer
I identify my gender as *
Different identity (please state)
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Birth Date (MM/DD/YYYY) *
Your answer
Email Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Parent Last Name (Required if you are a volunteer under 18; if not applicable insert n/a) *
Your answer
Parent First Name (Required if you are a volunteer under 18; if not applicable insert n/a) *
Your answer
Parent Cell Phone (Required if you are a volunteer under 18; if not applicable insert n/a) *
Your answer
Parent Email (Required if you are a volunteer under 18; if not applicable insert n/a) *
Your answer
What school do you currently attend? *
Your answer
Education (Current status) *
Grade Level *
Are you a current Breakthrough Miami Scholar or Alumnus? *
Have you previously volunteered at a Breakthrough? *
If you answered yes, which site? What was your role?
Your answer
Our school year program operates from October 7th to April 28th (Saturdays). Please list any dates that would conflict with you being able to volunteer. *
Your answer
What form of volunteering would you prefer to do? *
How did you hear about us? *
I understand that I must complete the above required enrollment documents and online training BEFORE I will be allowed to volunteer with Breakthrough Miami. (These requirements are located in the description at the top of this form.) *
Required
Comments/Notes for Site Director(s)
Your answer
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