OISC & THINK Together Volunteer Application

Name

Address

City                      State     Zip Code

 Home Phone                  Work Phone

Email Address     Date of Birth  (MM/DD/YYYY) //

Drivers License No.     Occupation              College Student Managment Engineer Marketing Optics Professional Retired Teacher

Primary Language Spoken     English Spanish Vietnamese Other         Secondary Language Spoken (none) English Spanish Vietnamese Other

Please indicate the age group with you wish to work                    (no preference) Grades 1 - 5 Grades 6 - 8 Grades 9 - 12

Do you have any special needs to be able to volunteer?  (none) Wheelchair Accessibility Physical Assistance Other

Have you ever been accused, arrested, or convicted for any sexually related crimes?  Yes No

Have you ever been arrested or convicted of a substance abuse related crime?            Yes No

Have you ever been convicted of a felony?                                                                     Yes No

Can you participate in the after school programs in December?                                    Yes No

If yes, can you participate one week or two?                                                                 Two One

Can you participate in the training sessions in November?                                            Yes No

Other Information

  APPLICANT'S STATEMENT
        The information contained in this application is correct to the best of my knowledge. I authorize any references or organizations listed in this application to give you any information they may have regarding my character and fitness working with children, and I release all such references from liability for any damage that may result from furnishing such evaluations to you. I understand that any personal information will be held in strict confidence.

        I also agree to hold harmless OISC & THINK Together, it's partners, their boards and commissions, and their officers, agents, and employees from and against all claims, loss, or liability of any kind or nature for any possible injury incurred during volunteer service.