Applicant information

First name

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Last name

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Phone

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Phone type
Email address

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Email type

Address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Date of birth

Month

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Day

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Year

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Background

Gender

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Ethnicity

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Education

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Languages
A.

About You

Why are you hoping to tutor a young person with Simpson Housing Services?

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Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):

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Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.

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Please describe your experience working with people from a variety of cultural backgrounds.

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What are your hobbies and interests?

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What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.

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Do you have a license in education?

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Employer

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What is your occupation (current or previous)?

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Can you commit to the Simpson Reading Tutoring Program for the school year, participating in weekly tutoring sessions?

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Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, unpredictable work schedule, major life changes, etc.)?

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Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

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Occasionally we are unable to place tutors because we have limited space, or a tutor’s schedule doesn’t allow for a weekly commitment. In the event that we cannot place you for weekly tutoring, would you be interested in being a substitute tutor? Substitute tutors are contacted when regular tutors are on vacation.

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Students participating in the tutoring program are invited to attend monthly enrichment outings. Outings are typically on Saturday mornings and we need a few volunteers to assist with each outing. Is this something you would be interested in helping with?

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Sometimes we bring young people from off-site to tutor at Passage, and we may ask volunteers to help with transportation. Would you be willing to use your personal vehicle to bring participants to and from tutoring?

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Do you have a current license and reliable vehicle?

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Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?

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Have you ever been refused participation in any other youth program? If yes, please explain.

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Have you ever been convicted of a crime? If yes, please explain.

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B.

Personal References

For each reference please include name, email, and phone number.

Reference #1 Name: First and Last

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Reference #1: Email

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Reference #1: Phone

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Reference #2 Name: First and Last

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Reference #2: Email

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Reference #2: Phone

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Reference #3: First and Last

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Reference #3: Email

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Reference #3: Phone

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