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Communities In Schools of South Central Texas, Inc. MENTOR APPLICATION Please Print: Date:_________Full Legal Name: _____________________________________________ Addresss:_______________________________City/State/Zip: _______________________ Home phone:(___)_____________ Cell phone: (____)____________ SSN#: ____________ DL#:_________________State:______________________DOB: _____________________ Email address: _____________________________________________________________ EDUCATIONAL BACKGROUND: Highest level of Education (check one): ____GED____HS Grad ___ Tech Grad ____SomeCollege ____College Grad ___Post Bachelor's EMPLOYMENT INFORMATION: (if employed, or past employer if retired) Employer name and adddress: _________________________________________________ __________________________________________________________________________ Work phone & extension:_______________Your Position or Title: __________________ May you be contacted at work? __________
If you have been employed by your present employer for less than one year, please give the name and address of the company you previously worked for: ________________________ ______________________________________________________________________________________________________________________________________________________
VOLUNTEER HISTORY: Have you ever been a volunteer or a mentor? ____________ If so, where? ______________________________________________________________________________________________________________________________________________________
What have you enjoyed most about your volunteer experiences? ______________________________________________________________________________________________________________________________________________________
Please share why you want to be a volunteer or a mentor for CIS? ______________________________________________________________________________________________________________________________________________________
PROGRAM INTERESTS: There are a variety of volunteer activities you might be interested in. To help us have an idea of how we could best use your talents, please circle the following: Mentor Read with students Lunch Buddy Arts & Crafts Leader Party Organizer Special Projects Refreshment Donor Homework Helper Play board games with students Field Trip Chaperone
Please indicate probable days and times available between 8:00 a.m. and 3:30 p.m.
From To From To Monday ________ ______ Thursday _______ _______ Tuesday ________ ______ Friday _______ _______ Wednesday ________ ______ Do you have any other special skills, interests, or talents that you could share with the CIS program? (Including speaking or writing in another language. Please list language and skill level). ______________________________________________________________________________________________________________________________________________________ Do you prefer to work with any specific grade levels? Check all you could agree to work with. _______ Primary (Pre-K - 1st) ________ Elementary/Intermediate (2nd - 6th) _______ Middle (7th - 8th) ________ High School (9th - 12th)
Do you prefer to work at a specific campus? _______ (If yes, circle your preferences)
NEW BRAUNFELS ISD COMAL ISD MARION ISD Memorial Primary Goodwin/Frazier Elementary Krueger Elementary Memorial Elementary Bill Brown Elementary Marion High School Memorial Intermediate Comal Elementary Lone Star Elementary Freiheit Elementary SEGUIN ISD Lamar Primary Hoffmann Lane Elementary Saegert 6th Grade Center Carl Schurz Elementary Startzville Elementary Seele Elementary Rahe/Bulverde Elementary SCHERTZ/CIBOLO/UCISD Oak Run 6th Grade Center Rebecca Creek Elementary Rose Garden Elementary New Braunfels Middle Specht Elementary Wiederstein Elementary New Braunfels High Arlon Seay Intermediate Canyon Middle Smithson Valley Middle Spring Branch Middle Canyon High Smithson Valley High REFERENCES: Name: ____________________________________________ Years known: ___________ Address:__________________________________________________________________ Work Phone: (_______)_________________ Home phone: (____)___________________ Best time to call:____________________________ Relationship: ____________________
Name: ____________________________________________ Years known: ___________ Address: __________________________________________________________________ Work Phone: (________)________________ Home phone: (____)____________________ Best time to call: ___________________________ Relationship: ____________________
Please list the names and telephone numbers of anyone you think would make a good volunteer: ______________________________________________________________________________________________________________________________________________________ THANK YOU so much for your interest in volunteering with CIS of South Central Texas, Inc. We appreciate you sharing your personal information with us, and hope you understand the need for us to complete the required criminal background check. I hereby authorize Communities In Schools of South Central Texas, Inc. to conduct a criminal background check on me as required by the CIS State policies.
Signature of Applicant: _______________________ Date: ______________ |