Name
Address
City
Postal Code
Transportation
Date of Birth
Home Phone
Work Phone
Cell Phone
Fax
Email
Employer
How would you like to be contacted?
Home Work Cell Email
Do you give permission to LCYS to share your phone number with your student?
Yes No
Please check the areas where you would be interested in volunteering for the council :
Tutor Board member Trainer (for tutors) Office Help Fundraising Marketing/Promotion
What is your level of education?
How did you find out about our agency and this volunteer opportunity?
Please describe your occupation or area of work experience.
Please describe other relevant jobs or volunteer experience.
What hobbies or interests do you have?
Availability We ask our volunteers to commit to a minimum of two hours per week for at least 12 months. Volunteers meet with their learners once a week. Please indicate when you think you'll be available. Monday 9 a.m.-12 p.m. 12 p.m.-5 p.m. Tuesday 9 a.m.-12 p.m. 12 p.m.-5 p.m. 5 p.m.-9 p.m. Wednesday 9 a.m.-12 p.m. 12 p.m.-5 p.m. 5 p.m.-9 p.m. Thursday 9 a.m.-12 p.m. 12 p.m.-5 p.m. 5 p.m.-9 p.m. Friday 9 a.m.-12 p.m.
Subjects and Levels We tutor learners who range in skill level from K to Gr. 10+ (Literacy & Basic Skills Levels 1-5). Please indicate the level and subjects you are interested in tutoring. Reading Beginners (Grd K-5) Advanced (Grd 6-10+) Writing Beginners (Grd K-5) Advanced (Grd 6-10+) Math Beginners (Grd K-5) Advanced (Grd 6-10+) Computers Beginners (Grd K-5) Advanced (Grd 6-10+)
Other Considerations Please mention any other information we should consider in matching you with a literacy learner, for example: allergies, male/female preference, smoker/non-smoker, year round availability, etc.
Please answer the following two questions in your own words. We will take both the information and the clarity of expression into account in assessing your suitability to become a literacy tutor.
1. The International Adult Literacy Survey (1994) revealed that 42% of adult Canadians do not have literacy skills necessary to function fully in society. What, in your opinion, are some of the factors that have caused this situation?
2. Please explain why you are interested in becoming a literacy tutor.
Would you submit to a police check, if required?
Yes No
We will be calling your references prior to you starting your volunteer position. We will be asking your references about your ability to handle a position of trust. Please provide a personal and professional reference (if applicable).
References
1.
Name
Phone
2.
Name
Phone
Release for Reference Checks I give permission to Literacy Council York-Simcoe to contact the references provided, regarding the application to volunteer with LCYS. All of the information that I have provided in this application form is correct.
Literacy Council York-Simcoe Mission Statement Our goal is to improve reading, writing and math skills in York-Simcoe. LCYS Values We value an environment of respect and confidentiality for all. We value our ability to provide cost-effective training for students and volunteers. We value out ability to provide individualized training appropriate to the needs of the students. We value a supportive and empowering learning atmosphere for volunteers, students and the community. Have you read and understand our mission and values?
Statement of Confidentiality I, the undersigned, do willingly promise to hold in confidence all confidential matters that come to my attention while involved with Literacy Council York-Simcoe. Matters considered to be confidential include, but are not limited to: personal information; personal issues; matters of litigation; agency related information regarding students, volunteers and staff of LCYS. I agree that any information that I gain will be used in a responsible manner, and only in relation to my responsibilities with LCYS during my time with LCYS or any time thereafter.
Waiver In consideration of accepting this assignment, I hereby for myself, my heirs, administer and assigns waive and release any and all right and claim for damages against Literacy Council York-Simcoe, Board of Directors, staff, volunteers and any association connected with it, their successors and any and all injuries by/to me during my involvement with the Literacy Council York-Simcoe.