Fall 2018 Volunteer Interest List
Thank you for expressing interest in volunteering with CHAT. Please complete this form with your Fall 2018 schedule in mind as we will reach out in August to place you at one of our sites. Below is a position description:

The ideal volunteer is a self starter who works well with others from a diverse background. Good communication, interpersonal skills, and adaptability are also necessary. The candidate should enjoy working with youth.

After-School Mentors make a semester long commitment to mentor one of our K-12 students, longer commitments are encouraged. After School Mentors focus on building a trusted relationship with their mentee, and the other students at the program. Most of the time will be spent in a one on one setting where mentors provide homework help and do activities designed to build relationship and promote education and/or interpersonal skills, which could include but are not limited to reading together or playing games. After School Mentors communicate concerns, and work with other volunteers and CHAT staff to improve the experience for all. All After-School Program Mentors are required to attend a training.

Email address *
First Name *
Your answer
Last Name *
Your answer
Gender
Occupation and/or School Name *
Your answer
How did you hear about CHAT? *
Your answer
Which Day/s of the week are you available? *
Required
Bus Captain (Can you commit to arriving 30 minutes early or staying 30 minutes late to be an extra adult on the bus route?)
Which age group do you prefer? *
Volunteer Background Check
This form authorizes CHAT to obtain background information and must be completed by the applicant. CHAT must keep this completed form on file for at least five years after requesting a background check. In the interest of safety and security I, the undersigned applicant (also known as "consumer"), authorize Church Hill Activities and Tutoring through its independent contractor, LexisNexis, to procure background information (also known as a "consumer report and/or investigative consumer report") about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Church Hill Activities and Tutoring, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act. *
Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations such as non-reckless speeding tickets) *
Has your conduct with children, youth or adults ever been cause for investigation, arrest, or any other legal proceeding by a social services agency, child abuse registry, or law enforcement authority? *
Has your personal or professional interaction with children ever led to disciplinary action by an employer, church, or other organization? *
If you answered yes to any of these questions please explain (or as mentioned above you may discuss these matters with a CHAT staff member for the area in which you would serve)
Your answer
First and last name for Background Information Agency (also known as "Consumer Reporting Agency") *
Your answer
Spouses Name (If Applicable)
Your answer
Other names used (maiden, nickname etc.)
Your answer
Address 1 *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Social Security Number (Necessary to complete background check. If you prefer, you may call the Volunteer Coordinator to communicate your social security number for your background check.) *
Your answer
Daytime Phone Number *
Your answer
Driver's License Number
Your answer
Date of Birth *
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Electronic Signature *
Your answer
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