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Volunteer Application
Roseville Adult learning Center
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* Indicates required question
First & Last Name
*
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Birthday
*
MM
/
DD
/
YYYY
Best time / means of contact
*
Your answer
Address
*
Your answer
City, State
*
Your answer
Zip Code
*
Your answer
Gender
Female
Male
Prefer not to answer
Other:
Clear selection
Ethnicity (optional)
Asian
Black / African American
White
Native American
Two or more
Other
Clear selection
Country of birth
Your answer
Home Language
Your answer
Emergency contact name
*
Your answer
Phone # of Emergency contact
*
Your answer
Employment status
*
Employed
Student
Retired
Other:
Occupation - previous or current
*
Your answer
Highest level of education completed
*
High school graduate
Some college
Associate's degree
Bachelor's degree
Master's degree
Doctoral or Professional degree
Other:
Do you have/had a teacher's license?
*
Your answer
Hobbies/Interests
*
Your answer
Do you have any health concerns you would like to make us aware of?
*
Your answer
Do you need any additional accommodations?
*
Your answer
How did you hear about our program?
*
Your answer
Have you had any prior volunteer training?
*
Yes
No
Number of hours per week you would like to volunteer
*
Your answer
Availability - please check all the apply:
Monday
Tuesday
Wednesday
Thursday
Friday
Morning (Mon-Fr) 9:00am-1:00pm
Afternoon (Mon-Th) 1:15pm-3:00pm
Evening (Mon-Th) 6pm-8:30pm
Monday
Tuesday
Wednesday
Thursday
Friday
Morning (Mon-Fr) 9:00am-1:00pm
Afternoon (Mon-Th) 1:15pm-3:00pm
Evening (Mon-Th) 6pm-8:30pm
Time preference
*
Your answer
Areas of Interest
*
Assisting a student with special needs
Assist student fill out application/form
Citizenship class/information
Classroom Assistant
Computers
Conversation
Diploma/GED
English Learner Program
Math
One-on-one
Reading
Small Group
Required
Interest of students skill level
*
Beginning
Intermediate
Advanced
Diploma
Why are you interested in becoming a volunteer with the Roseville Area Adult Learning Center?
*
Your answer
Describe any cross-cultural experience or training you have.
*
Your answer
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