Literacy Volunteers of Rockland County
Tutor Application
Directions: Please complete and return to LVRC
220 North Main Street, New City, NY 10956
845-708-9072
DEMOGRAPHICS
Date___________________________
Name___________________________________________________________________________
Address ___________________________________________City _________________Zip________
Phone (Home) _________________________Work ____________________Cell________________
Gender _______________________Birthday_____/______/_______Age_______________________
EMAIL ADDRESS__________________________________________________________________
EDUCATION (Beyond High School) College/University___________________________________________________________________
Degree (s )________________________________________________Years Attended______________
Employment____________________________________________________________
Status (Full time, Part time, Retired...etc/}_________________________________________________
LANGUAGE Native Language_____________________________________________________________________
Knowledge of a language other than English_______________________________________________
TUTORING/TRAINING PREFERENCES Day (s) of the week available__________________________________________ Time (s)_________________________________________________________
Libraries: 1)________________________2)____________________________
Age: (Check appropriate range) 18-24______25-44______45-59_____60+______
No preference ______Gender: M _______F________ No preference______
Maximum miles I would be able to drive to meet my student:___________
BECAUSE OF UNCERTAINTIES REGARDING TIMES, LOCATION, ETC.
YOU SHOULD BE ABLE TO DRIVE YOURSELF TO THE TUTORING SITE.
COMMENTS:________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
OTHER How did you hear about Literacy Volunteers? ________________________
Could you help LVRC in other ways than tutoring, such as testing, fund raising, promotions, etc. ______________________________________________________________
Have you tutored in the past? (If yes, doing what) ________________________ _____________________________________________________________
Are you a member of any community organizations? (If yes, which ones_______ _____________________________________________________________
What are your hobbies/interests?: _________________________________ _____________________________________________________________
Please list other volunteer experience you have: ________________________ _____________________________________________________________
Please use the space below to provide additional information or comments: