SYP 17-18 BTM Miami Country Day Volunteer Interest Form
Our school year program operates TWO Saturdays a month between OCTOBER 2017 and APRIL 2018. Please complete this form and the Breakthrough site staff at Miami Country Day 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
Volunteers 18 years of age and older, who are working directly with Scholars, need to complete the form and take it with them when they get fingerprinted.

6. VECHS Waiver
Volunteers 18 years of age and older, who are working directly with Scholars, need to complete the form, leave a copy at the Breakthrough Miami site office where they will be volunteering and take the original when they get fingerprinted.

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 18 years of age and OVER please PRINT and COMPLETE the following:
https://drive.google.com/a/breakthroughmiami.org/file/d/0B9Om6tsXvHDgTkhzZzM2T01Kd0E/view?usp=sharing

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

Last Name *
First Name *
I identify my gender as *
Different identity (please state)
Home Address *
Birth Date (MM/DD/YYYY) *
Email Address *
Home Phone *
Cell Phone *
Parent Last Name (Required if you are a volunteer under 18; if not applicable insert n/a) *
Parent First Name  (Required if you are a volunteer under 18; if not applicable insert n/a) *
Parent Cell Phone  (Required if you are a volunteer under 18; if not applicable insert n/a) *
Parent Email  (Required if you are a volunteer under 18; if not applicable insert n/a) *
What school do you currently attend? *
Education (Current status) *
Grade Level *
Have you previously volunteered at a Breakthrough? *
If you answered yes, which site? What was your role?
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. *
Please check the times you are available to volunteer *
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)
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