VOLUNTEER APPLICATION FORM

If you experience problems with this online form, you can also download a Word version and mail it or fax it back to us

First Name:
Middle Name:
Last Name:
AKA (Maiden or other name changes):
Home Information
Street Address:
City:
Zip:
Home Phone
Cell Phone:
Email:
Best way to contact you between the hours of 4pm-7pm email home phone cell phone
How long have you lived at this address?
How long have you lived in CA?
If applicable, please list other cities or states you have lived in the past 10 years.
Personal Information
Gender Female Male
Soc. Sec. #:
Date of Birth:
Birthplace (city, state, country)
Marital Status (single, married)
Ethnic/Racial identity:
What other languages you speak (besides English):
Do you have a car? Yes    No
CA Driver's License Number:
Expiration Date:
Insurance provider:
Policy #:
   
Whom should we notify in case of emergency?
Relationship:
Phone #:
   
All mentors will be fingerprinted for security purposes  
Have you ever been arrested? Yes     No
Have you ever been convicted of any criminal charges? Yes     No
If yes, please list all cases, without exception
(offence, date, action):
Do you have any children? If so please list names and ages:
Work Information
Occupation:
Current Employer:
Work Address:
City:
Zip:
Work Phone:
Work Hours:
How long have you been with this employer?
Please list employment history or send resume by email:
Academic History
Name of Undergraduate College:
Location:
Degree/Major:
Field of Study:
Graduation Date:
List any special training or certifications or postgraduate degrees:
Additional Questions
Based on your own experiences as a middle school student, what do you think are the knowledge, skills, and resources young adolescents need to succeed?
What previous experience have you had with youth? If you have not had any experience with youth, what gives you confidence that you will be able to mentor or tutor a youth?
Please briefly explain why you would like to be a volunteer tutor and/or mentor:
List and explain extra curricular activities, interests, skills and/or hobbies:
Please list organizations with whom you have volunteered in the past:
Organization:
Length of Time
Position
Phone Number
May we contact them? Yes    No
   
Organization:
Length of Time:
Position:
Phone Number:
May we contact them? Yes    No
Organization:
Length of Time:
Position:
Phone Number:
May we contact them? Yes    No
Please list any professional memberships, community organization affiliations, etc:
Do you know of any reasonable expectation of any future changes in your family status, vocation or residence? Yes    No
If yes, please explain:
Please list 3 references who can tell us about how you relate to others, esp. youth. Please refrain from listing relatives, unless they have had a supervisory role over you.

Reference 1: employer / supervisor / business associate
Reference 2: Personal Reference (do not list relatives)
Reference 3: Personal Reference (do not list relatives)
Name:
Relationship:
Phone #:
   
Name:
Relationship:
Phone #:
   
Name:
Relationship:
Phone #:
SMART is looking for volunteer mentors, tutors, and mentor/tutors. Mentors meet with their student every week for 2-4 hours. Tutors meet one day a week from 5:30-7:00pm. Mentor/Tutors meet one day a week for tutoring from 5:30pm-7:00pm and mentor 2 weekends a month for 2-4 hours. Which role are you interested in?

Mentor

Tutor

Mentor/Tutor
Volunteer training sessions are required by this program, as well as a commitment to work with a child for a minimum of 2-3 hours per week for one full year. Can you fulfill these requirements? Yes    No
At this time, the time commitment I can make to the SMART program is:

No more than 1 year

More than a year
How did you find out about theSMARTprogram? Please explain in detail. (Friend/colleague - please list their name; Volunteer Center of SF; Volunteer Match website; Craigslist; Other)
I have read the volunteer application and agree to abide by the commitments made in it. The information I have provided in this application is true to the best of my knowledge. I understand that by submitting this application, I am authorizing inquiries to be made concerning my suitability as a volunteer. This will include a check for any past criminal record. The information requested in this application and that, which may be subsequently obtained, will be used only for the purpose of determining my appropriateness as a volunteer. All information will remain confidential.
Name of Applicant:
Date:

For volunteer questions, please call Cindy at (415) 865-5400 or email her.