Volunteer Application

Thank you for your interest in becoming a volunteer at the Learning and Tutoring Center of East Austin.
Information provided on this form will be kept confidential. All volunteers must agree to a criminal
background check. Please complete and return this application to the mailing address below.
Date:_______________________

__Male

__Female

Name:__________________________________________________________________________
Last
First
Middle Initial
Address:_________________________________________________________________________
Street
City
State
Zip
Birth Date:____________________________
E-mail Address:___________________________________________________________________
Home Phone: (

)___________________

Alternate Phone: (

)____________________

Current Employer:_________________________________________________________________
Personal References: (1)____________________________________________________________
Name
Phone Number
(2)____________________________________________________________
Name
Phone Number
How did you hear about our program?_________________________________________________

Please check the appropriate boxes:

I am available to volunteer for the Summer Tutoring Enrichment Program on July 5 29, 2011
Monday Friday, 10:00 a.m. 12:00 p.m.
I am available only on the day(s) I have highlighted. Monday Tuesday Wednesday Thursday Friday
I would like to tutor children in: Reading Math Writing
I am not interested in tutoring, but would like to volunteer in other areas as needed.
Signature & Date:___________________________________________

Mailing Address: P.O. Box 140341 Austin, TX 78714-0341

Phone/Fax: (512) 926-8866 or (512) 302-5830
Email for LaVerne Banks: banks_laverne@yahoo.com