Name____________________________________________________ Phone__________________________
 Address__________________________________________________ e-mail_________________________________
             ___________________________________________________

Are you interested in working as ...                Volunteer                 Work-Study

Are you interested in working as...                 Literacy Buddy        Storybook Tutor        Math Partner

Please write down your course schedule for the semester. This is important in developing a regular work schedule for you.
 

	Monday	Tuesday	Wednesday	Thursday	Friday
Mornings
Afternoons
Evenings

How many hours per week and what days are you planning to work?
 
 
 

Why are you interested in this kind of work?
 
 
 

What are your previous experiences working with children?
 
 

Provide two personal references.
 
 
 

For Literacy Buddy or Storybook Tutor positions only:
What experiences have you had working in school settings or working with children in reading and writing?
 
 
 

For Math Partner positions only :
What math courses did you take in high school and college?
 
 
 

For Math Partner positions only:
What experiences have you had working in school settings or working with children in mathematics?
 
 
 

For Literacy Buddy, Storybook Tutor and Math Partner positions
Is there anything else you would like us to know about you as an employee, volunteer or as a learner that will help us to make this a positive experience for you?
 
 
 

Please remember that your contract needs to be signed by you and your site supervisor before you start working.