Date:                                   

Name:                                                      

Address:

Day Phone:                              

Night Phone:

Email:                               

Birth date:                              

Age:

Sex:

Employer:

Full-time

Part-time

Retired

Are you a student? No Yes     If so, where?  

Year of Graduation:

Do you have special training and/or skills related to adult literacy?

Do you have additional information that might be helpful such as hobbies, travel, other volunteer

experiences, additional languages spoken, etc:

If you would like to become a volunteer tutor please complete the following...

Are you available to start tutoring immediately?

Educational Level:

Vocational Background:

Do you have previous teaching, training or tutoring experience? If yes, list the date, location and type

of teaching, training or tutoring experience:

I have strengths in these subject areas:

Spelling        Writing         Mathematics        Other:

Can you commit to two hours a week of direct instruction, plus additional hours for preparation, for one year?

Would you consider being a small-group tutor (3-5 learners)

Can you attend the 6-week follow-up session?

If you can only commit to 1 hr wkly or less than one year, can you...

Tutor a GED class    Tutor a Citizenship class    Tutor an advanced student    Assist a small-group tutor

If you would like to volunteer but cannot commit to weekly tutoring, can you...

Assist in the office                                                    

Provide computer technical support

Contribute to the quarterly newsletter                    

Assist in grant writing

Assess ESL student (we will train)                           

Assist with the annual auction (as a solicitor, etc.)

Post training flyers                                                     

Assist with bookkeeping

Communicate with our ESL learners (bilingual individuals, Spanish and Russian)

Assist with events (International Festival, Kid's Book Festival, etc.)

When are you available for tutoring?

Student sex preferred:

Student age preferred:

At this point would you like to tutor a Basic Literacy adult student or an ESL adult student?

Student reading level preferred: Grades 0-4        Grade 5-8        Grades 9-12        GED         No Preference

ESL level preferred: Beginning         Intermediate         Advanced         No Preference

The Harrisonburg/Rockingham country area has a large population of Hispanic, Kurdish, and Russian community

members in need of literacy services.  Do you have experience working with any of these particular ethnic/language

groups?  If yes, please list the groups:

Do you have transportation?

Where can you meet your learner? their home      your home      public place       no preference

How far are you willing to travel?  Within miles of my home

Geographical preference for tutoring:  Town and/or city

Northern Co.         Southern Co.         Eastern Co.         Western Co.            no preference

In the future, would you like to attend a three-hour workshop to learn how to tutor both ESL and Basic-Literacy learners?

Please register me for the tutor training on

                    *See calendar for upcoming tutor trainings.

How did you hear about Skyline Literacy Coalition?

Comments:

             Name: