Telephone (Home)

Name:

Date:

Address:

Telephone (Home)

City:

Zip:

(Work)

e-mail

(Cell):

How did you hear about us?

Background:

Why do you want to volunteer at KACE?

What is your professional background?

Please list your volunteer experience

What do you hope to gain from the experience?

If you are interested in being a tutor, please answer the following:

Please describe any experience with at-risk populations.

What personal challenges do you see in tutoring adults?

Please describe any training or education you have had which would be an asset in tutoring adults.:

Foreign language spoken or relevant foreign travel?

Volunteer Opportunities/Preferences
Please check boxes that represent when you are currently available.

	Monday	Tuesday	Wednesday	Thursday	Friday	Weekend
Morning
Afternoon
Evening

Tutoring:
I am interested in tutoring in:

English for non-Native speakers:  Math:  Reading & Writing Skills for native English speakers: 

Do you have a preference for a specific type of student? Yes  No 

If so, please describe:

Are you willing to work with a student who is developmentally delayed and/or a slow learner Yes  No 

Do you smoke? Yes  No 

Are you willing to work with a student who smokes, but not during the session Yes  No 

Please check all areas in which you are willing to tutor:



East Bremerton 

West Bremerton 

Silverdale 

Seabeck 

Bangor 

Bainbridge Island 

Hansville 

Kingston 

Poulsbo 

Port Orchard 

Belfair 

TRANSPORTATION: Bus  Car  Other 

Non-Tutoring Opportunities (Please check if you are interested):

Data Entry
General Office Assistance
Fund-raising
Publicity (Information tables, pubic speaking, help with mailings.
Board of Directors
Computer/Technology (Please describe your specific skills and interests):
Other (Please describe):

Before you may be accepted as a volunteer, it is necessary for you to pass a Washington State Patrol Criminal History Check. A criminal history does not necessarily exclude you from volunteering. If you have any past criminal offenses which you would like to disclose at this time, please submit on a separate sheet of paper.

The following information is voluntary and will not affect your application. It is requested by funders or by state and national adult education organizations for statistical purposes:

Date of Birth:

Gender:

Race/Ethnicity (Please check all that apply):

• 
  Asian
  
• 
  American Indian/Alaskan Native
  
• 
  Black/African American
  
• 
  Hispanic
  
• 
  Native Hawaiian/Other Pacific Islander
  
• 
  White
  
• 
  Other Multi-Racial:
  

Occupation
Current 		Previous 
Employer:
Full-Time 		Part-Time 	Retired: 

Education:

Total Years Education

 High School
 Some College
 College Grad		Degree			Major
		College/University
 Post Grad
 Other Education/Training: