2024/2025 Volunteer Interest Form
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Email *
First Name *
Last Name *
Address Info:
Street
City
State
Zip
Phone *
Occupation *
Education
*
Special Skills/Talents
Are you an alumni of the W.E.B. DuBois Learning Center?
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How did you become interested in the Learning Center?
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Volunteer Opportunities - Areas(s) of Interest
Please check all that you are interested in.
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Required
Please answer with your full name for each date you can volunteer in
SEPTEMBER 2024
All Saturdays in September, 10:30am to noon
All Mondays in September, 6pm to 7:30pm
Sat., September 7, 2024, 10:30am to noon
Mon., September 9, 2024, 6pm to 7:30pm
Sat., September 14, 2024, 10:30am to noon
Mon., September 16, 2024, 6pm to 7:30pm
Sat., September 21, 2024, 10:30am to noon
Mon., September 23, 2024, 6pm to 7:30pm
Sat., September 28, 2024, 10:30am to noon
Mon., September 30 2024, 6pm to 7:30pm
Please answer with your full name for each date you can volunteer in
OCTOBER 2024
All Saturdays in October, 10:30am to noon
All Mondays in October, 6pm to 7:30pm
Sat., October 5, 2024, 10:30am to noon
Mon., October 7, 2024, 6pm to 7:30pm
Sat., October 12, 2024, 10:30am to noon
Mon., October 14, 2024, 6pm to 7:30pm
Sat., October 19, 2024, 10:30am to noon
Mon., October 21, 2024, 6pm to 7:30pm
Sat., October 26, 2024, 10:30am to noon
Mon., October 28, 2024, 6pm to 7:30pm
Please answer with your full name for each date you can volunteer in
NOVEMBER 2024
All Saturdays in November, 10:30am to noon
All Mondays in November, 6pm to 7:30pm
Sat., November 2, 2024, 10:30am to noon
Mon., November 4, 2024, 6pm to 7:30pm
Sat., November 9, 2024, 10:30am to noon
Mon., November 11, 2024, 6pm to 7:30pm
Sat., November 16, 2024, 10:30am to noon
Mon., November 18, 2024, 6pm to 7:30pm
Sat., November 23, 2024, 10:30am to noon
Mon., November 25, 2024, 6pm to 7:30pm
Please answer with your full name for each date you can volunteer in
DECEMBER 2024
All Mondays in December, 6pm to 7:30pm
All Saturdays in December, 10:30am to noon
Mon., December 2, 2024, 6pm to 7:30pm
Sat., December 7, 2024, 10:30am to noon
Mon., December 9, 2024, 6pm to 7:30pm
Sat., December 14, 2024, 10:30am to noon
Mon., December 16, 2024, 6pm to 7:30pm
Sat., December 21, 2024, 10:30am to noon
VOLUNTEER STATEMENT AFFIRMING UNDERSTANDING

I understand that I must have a background check on file with the DuBois Learning Center. I understand that the role and responsibility of a volunteer is important and that information regarding students, families, staff, and the organization may be confidential in nature. As a volunteer for the W.E.B. DuBois Learning Center, I will: Respect the confidential nature of any verbal or written communication I receive regarding students, families, staff and the organization and keep personal information confidential at the Center and after I leave the Center. Be discreet in any verbal communication, by not discussing students, staff, or families in front of others. Immediately report directly to the Director, or other appropriate leadership, any information disclosed to me concerning a student’s safety. Make reasonable efforts to assure that each student is protected from bullying, harassment or discrimination. Not discriminate against any student, staff member or volunteer on the basis of race, color, religion, sex, age, national or ethnic origin, political beliefs, marital status, handicapping condition, sexual orientation, or social and family background. Acknowledge that relationships developed with students need to remain at the Learning Center unless appropriate notification and release has been completed by parent and organization. Refrain from initiating or engaging in Social Media relationships with students and agree that any services or meeting outside of the Learning Center will be acknowledged and approved by both the organization and the parent prior to the services and/or meeting. Not communicate with a student outside of the regular scheduled session without the permission of DLC and the student’s parent.

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By TYPING "I AGREE" below and submitting this form, you are stating that all the information you provided is true and accurate to the best of your ability AND that you agree to abide by the VOLUNTEER STATEMENT AFFIRMING UNDERSTAND.
A copy of your responses will be emailed to the address you provided.
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