Volunteer Application Winter 2018
Welcome to Amigos de UCLA! Please fill out this application and submit it by Monday, January 8th at 11:59 pm. We will review the applications and let you know our decision on Tuesday, January 9th.

Training will take place Week 1 of Winter during the site time of the day you select. Site will begin Week 2 and run through Week 9.

Sincerely,
The Amigos de UCLA Directors

Name *
First and Last
Student ID # *
Cell Phone Number *
(XXX)XXX-XXXX
Email Address *
Please provide an email you check regularly.
Are you a new or returning volunteer? *
Why do you want to be a part of Amigos? *
*If you are a returning volunteer, please explain why you would like to return.
Why do you think mentorship and community engagement are important? *
If you are a NEW volunteer, have you worked with children, or tutored in any age group before? If so, please describe your experience(s).
*Returning volunteers, please leave this section blank.
For returning volunteers, is there a mentee (or mentees) you would like to work with again next quarter?
Year in School *
Major *
What subject(s) would you like to tutor in? (High School Applicants)
Do you speak Spanish? *
Your response will not influence your acceptance into the program.
Site Availability (Pick Your First Choice) *
All sites meet weeks 2-9, except on holidays. You must attend your site day each week.
Is there a different day of site (other than your first choice) that you are available to attend? *
If your first choice is full, you will be placed in your second choice.
Have you been TB tested in the last two years? *
*If you have been TB tested please have a copy of the results at hand.
If you do not have a TB Test: *
All volunteers in LAUSD are required to show proof of a tuberculosis test. If you do not have an up-to-date immunization (within the past 3 years), please visit the Ashe Center. You can do a walk-in appointment at the first floor of Ashe Center. Please be pro-active in ensuring you have a copy of your test results before site begins.
How did you hear about us? *
Required
Emergency Contact *
In the event of an emergency at site, we would like a contact to inform as soon as possible. This can be a parent, family member, friend or roommate. Please include a NAME and PHONE NUMBER.
Waiver of Liability *
In case of emergency, I authorize Amigos de UCLA staff to take me to the nearest emergency facility and for them to administer the treatment necessary for my safety and protection. I understand that Amigos de UCLA has no insurance covering such medical or hospital costs, and therefore, any cost incurred for such treatment shall be my sole responsibility. Amigos de UCLA nor the University of California will not compensate, insure or indemnify you for any incident, loss of property, illness or injury that may occur during the activity.
Volunteer Contract *
By checking each box, you agree to the following volunteer expectations:
Required
Please provide your electronic signature *
Sign your name
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