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Empowerment through Academics (E.T.A.)

Tutor (Volunteer) Application Packet
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I. Regulations

 As a volunteer/intern with the A Higher Purpose Inc. Empowerment through Academics (E.T.A.),
I understand I will be volunteering, either directly or indirectly, with women who are potential
non-traditional students (students who are married, have children, or who are aged 24 or older)
who are beginning or returning to college and is being provided service by A Higher Purpose,
Inc.
 I understand that compliance with all of the requirements below for me is mandatory for
volunteerism with A Higher Purpose Inc. for everyone’s safety: The references I listed may be
contacted by telephone, mail, or email.
 I understand that A Higher Purpose Inc. has my permission to use my name and photographs of
me to promote the organization.
 I will inform A Higher Purpose Inc. staff member or the Empowerment through Academics
(E.T.A.) of any previous injuries that may affect my ability to safely complete volunteer tasks,
including lifting. I understand that I must carry my own health insurance.
 I will not hold A Higher Purpose Inc. responsible for any unforeseen injuries or problems that
may occur on the volunteer site.
 I understand I may not initiate or engage in any media/public event pertaining to a refugees or the
organization without the approval of A Higher Purpose Inc. Requests for media engagements will
be referred directly to the A Higher Purpose Inc. Staff.
 I understand that I have the right to submit a grievance to the Executive Director of A Higher
Purpose Inc. should I not be satisfied with the response to the needs of, the interaction with,
guidance of, care for A Higher Purpose Inc. clients within the scope of A Higher Purpose Inc.
mission.
 I understand that A Higher Purpose Inc. is an A Higher Purpose, Incorporated was established in
Poteau, Oklahoma in 2009 as a community resource agency to provide assistance to less fortunate
single and married women aged 21-40 who may qualify as a non-traditional college student who
is single with children, married, or who works full-time.
 These individuals are motivated to begin or return to college in order to create economic stability
and mental empowerment.
 A Higher Purpose, Incorporated provides Compass Exam preparation and tutoring, college
application assistance, and career mentors. Their goals are to: inform, empower, and equip
women through higher education.
 As a result of this action, it will unlock the potential of women to build strong families,
communities, sustain healthy relationships, and promote social, personal, and economic change.
 I will not abuse, neglect, exploit, coerce, manipulate, retaliate against or deny service to any of
the A Higher Purpose Inc. clients.
 I understand that I am expected to report any incident, action or circumstance which I may
become aware of that presents a threat, endangerment, or poses a current or future impact on A
Higher Purpose Inc. clients to the A Higher Purpose Inc. Staff or Volunteer Supervisor.
 I understand that it is especially important to inform the Staff in the case of a medical emergency,
in the case of a pertinent medical update or in the case of a client’s harmful threat to self or
others.
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 I understand that I may not be alone in the company of minor children without the presence of a
legal guardian. I will not transport minor children or A Higher Purpose Inc. clients for any
purposes or the expressed consent of A Higher Purpose Inc. following a fingerprint background
check.
 I understand that I may receive personal information regarding A Higher Purpose Inc. client on
an as needed basis and the client may choose to disclose information. I understand that the client
information is confidential, especially addresses and contact information, and that it is not to be
disclosed to an outside party in written or verbal form, nor in an electronic communication such
as mail, website accessible by public, etc. 
 Many A Higher Purpose Inc. clients choose not to have their photos taken for personal and/or
security reasons. I understand that I may not photograph nor arrange for a photograph of clients
without first receiving approval from the A Higher Purpose Inc. Staff to ensure that A Higher
Purpose Inc. has obtained expressed written consent on A Higher Purpose Inc. consent form. 
 I understand all clients are to be treated with dignity, respect and consideration and are not to be
discriminated against based on race, national origin, religion, sexual orientation, age, disability or
marital status.
 I understand that the terms listed above are not all-inclusive and may be updated, as needed.

II. Application

1. Personal Information
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Last Name_________________ First Name______________ Middle Name_______________

Present Address___________________________ State______________ Zip______________

Daytime phone #___-___-___ Evening phone#___-___-___ Cell phone#___-___-___

Email Address_____________________ Social Security Number___/___/___

Emergency Contact Person_________________ Address________________________

Emergency Contact Person’s phone#_________________

Relationship of the Contact Person___________________________

Valid Driver’s License:

State issued____________________ Driver’s license#_________________________

Languages Spoken_______________________________________________________

Current Employer_____________________________Address_____________________

Current Employer phone#__________________

2. Volunteer Experience

Name of Volunteer Agency/Organization________________________________________

Volunteer Agency/Organization Address_________________________________________

Volunteer Agency/Organization phone #__________________

Volunteer Agency/Organization Supervisor Name______________________________

Dates of Volunteer work: Begin ______/______/______ Ended: _____/_____/____

Volunteer Experience

Name of Volunteer Agency/Organization________________________________________

Volunteer Agency/Organization Address_________________________________________

Volunteer Agency/Organization phone #__________________

Volunteer Agency/Organization Supervisor Name______________________________

Dates of Volunteer work: Begin ______/______/______ Ended: _____/_____/____

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Volunteer Experience

Name of Volunteer Agency/Organization________________________________________

Volunteer Agency/Organization Address_________________________________________

Volunteer Agency/Organization phone #__________________

Volunteer Agency/Organization Supervisor Name______________________________

Dates of Volunteer work: Begin ______/______/______ Ended: _____/_____/____

Volunteer Experience

Name of Volunteer Agency/Organization________________________________________

Volunteer Agency/Organization Address_________________________________________

Volunteer Agency/Organization phone #__________________

Volunteer Agency/Organization Supervisor Name______________________________

Volunteer Experience

Name of Volunteer Agency/Organization________________________________________

Volunteer Agency/Organization Address_________________________________________

Volunteer Agency/Organization phone #__________________

Volunteer Agency/Organization Supervisor Name______________________________

Dates of Volunteer work: Begin ______/______/______ Ended: _____/_____/____

3. References

Name: ________________ _____________________________

Relationship: _______________ Years Known: _________________________

Contact#:________________________Email:___________________________

Address: _________________________________________________________
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References

Name: ________________ _____________________________

Relationship: _______________ Years Known: _________________________

Contact#:________________________Email:___________________________

Address: _________________________________________________________

References

Name: ________________ _____________________________

Relationship: _______________ Years Known: _________________________

Contact#:________________________Email:___________________________

Address: _________________________________________________________

By mailing the application you agree to all terms and conditions listed in the above agreement for yourself
and minors participating in A Higher Purpose Inc. volunteer activities.

Signature__________________________________ Date_____________________________

Printed Name______________________________ Date______________________________

Notary Signature:

Notary Signature_____________________________ Commission: _______________________

Date: ________________________________________