The SMART Program

Volunteer Application

Contact Information

*First Name
*Last Name
*Address

*City *Zip code

*Email
*Cell phone
Home phone
Work phone
*Best way to contact you between 4 and 7 p.m. Cell phone Home phone Work phone Email

Personal Information

Date of birth
Gender
Marital status
Ethnic/racial identity
Spoken languages

*Emergency contact
*Relationship
*Phone

Work Information

*Employer
Job title
Address
City Zip code
Work hours
Start date

Prior employer
Job title
City State
Start date
End date

Prior employer
Job title
City State
Start date
End date

Education

*College or university
City State
Field of study
*Degree received
*Graduation date
Special training, certifications, postgraduate degrees

Volunteer Experience

Organization
Position
Phone
Length of time
May we contact them? Yes No

Organization
Position
Phone
Length of time
May we contact them? Yes No

Organization
Position
Phone
Length of time
May we contact them? Yes No

Additional Questions

*Briefly explain why you would like to be a volunteer tutor and/or mentor.

*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 personal characteristics or skills do you have that would help you to succeed as a mentor or tutor?

List and explain any extra curricular activities, interests, skills, and hobbies.

*Do you know of any reasonable expectation of any future changes in your family status, vocation or residence? If yes, please explain.

References

Please list two references who can vouch for your reputation, character, morals, and work ethic. Please refrain from listing relatives. Please provide us with one business reference and one personal reference. We prefer local references who have known you for at least two years.

Reference 1: Employer/Supervisor/Business Associate
*Name
*Title
City State
*Phone

Reference 2: Personal Reference (do not list relatives)
*Name
*Relationship
City State
*Phone

Commitment

SMART is looking for volunteer mentors, tutors, and mentor/tutors. Tutors meet one day a week from 5:30-7 p.m. Mentors meet with their student twice a month for 2-4 hours. Mentor/tutors do both. Which role are you interested in?
Tutor Mentor Both

Volunteer training sessions are conducted twice per year, and all volunteers commit to working with their student for one full year. Can you fulfill these requirements?
Yes No

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.

*Applicant name
*Date

"After six years of volunteering at SMART, it has been a rewarding experience to work with motivated and bright students, who exhibit curiosity and seek help. Being matched with the same student for three years, you can truly see the impact of this program on the students."
Sonia Fernandez
Tutor