Name	First	Preferred	Last
Address	Street Adress	City	Postal Code
Phone	Home	Work

Email			Preferred Method of Contact	Home	Work	Email

Age	19-25	26-34	36-55	56+		Gender	Male	Female

Occupation		Education	Grade 12 College/University	Teacher Training Postgraduate degree

How did you learn about the Centre for Family Literacy?

Areas of interest to volunteer	Adult Tutoring Reception Family Literacy Programs Special Events	Office Work Library Aide Fundraising

What are your special interests or hobbies:

What specific skills would you like to utilize:

List any previous volunteer experience:

Why are you interested in volunteering?

Other languages that you speak/read/write:

Availability - when and how often can you volunteer:	Sunday Monday Tuesday Wednesday Thursday Friday Saturday	Morning Afternoon Evening Once a week Other

For Applicants Interested in Tutoring Where would you be willing to tutor: The Centre Library or Public Location What part of city? Student preferences (please check as many as you think are applicable): Male Female Younger Adult Older Adult Smoker Nonsmoker Learning Disabled Physically Challenged Mentally Challenged ESL What grade level of student would you like to work with? 0-3 4-8 List any teaching experience: What makes you a good tutor?

Please Provide Three References (no family members please):

Reference 1	Name		Address
	Phone		Email
Context in which the person knows you			Years known

Reference 2	Name		Address
	Phone		Email
Context in which the person knows you			Years known

Reference 3	Name		Address
	Phone		Email
Context in which the person knows you			Years known

Do you agree to have a Security Clearance Check?	Yes	No		Do you agree to have an Intervention Record Check (if required for the position)?	Yes	No

Do you certify that the information you have provided on this application form is true and complete?	Yes	No
Do you understand and agree that any false statements made on this application would be adequate grounds for disqualification or dismissal?	Yes	No