Volunteer Application
Family Learning Center
Fields in red are required for submission, though all information is eventually needed to
process your application.


Date


1. Tell us something about yourself:

Full Name
Address
City
State
Zip
Home Phone
Work Phone
Fax
Email
Date of Birth
Social Security Number
2. Most Recent Work History


3. Most Recent Volunteer Work History


4. Education
Please include school name, city and state for high schools and colleges attended.


5. Which of the following activities interests you?
Tutoring/Homework Help
Mentoring
Chaperoning Activities/Outings
Fundraising/Special Events/Grant Writing
Office Help/Typing/Filing/Data Entry
Volunteer Coordination
Computer Lab
Board or Committee Membership
Translating Documents



6. What age of students are you interested in working with?
PreSchool
Elementary School
Middle School
High School
Adults



7. If you chose "Tutoring/homework Help in Section 5, what subjects are you most comfortable teaching?
English Composition
Social Sciences
Theater
French
Chinese
Latin
Math
Visual Arts
Computers
German
Russian
Accounting
Life Sciences
Music
Spanish
Japanese
Hebrew
Business

Other
Please explain.



8. If you chose "Mentoring" in question 5, please answer the next two questions

a.Please describe the skills, interests, hobbies, and similar characteristics that you are willing and able
to share with a child

b.What cultural, sports, or other recreational activities would you consider attending with a child?


9. How many hours can you volunteer per week?


10. What specific days of the week and times are you available?
 Anytime       Weekdays       Weekends

If you know more specifically, write the times you are available.
Adult program hours are Weekdays 8:00 am to 9:00 pm and on Saturday mornings.
School age program hours (Elementary, middle, and highschool) are Weekdays 3:00 pm to 5:30 pm.
PreSchool program hours are Weekdays 7:00 am to 4:30 pm.

 Monday       Tuesday     
 Wednesday       Thursday     
 Friday       Saturday     
 Sunday     


11. What qualities or characteristics do you think are important when working with youth/young adults?


12. What personal experiences have you had that you feel would be particularly helpful in your
volunteer work at The Family Learning Center?


13. Are you a U.S. citizen? Yes      No
14. If not, do you have a green card? Yes      No
15. Have you ever been involved, arrested or convicted of a criminal offense? Yes      No
16. Have you ever been the subject of a child abuse investigation? Yes      No
17. How did you find out about The Family Learning Center of Boulder County?      


18. Please list references (preferably local) you have known for two years.
Mentors should list three references and all other volunteers should list two.

Reference 1

Name:
Street Address:
City: State: Zip:
Home Phone: Work Phone:
Fax number:
Relationship to you:

Reference 2

Name:
Street Address:
City: State: Zip:
Home Phone: Work Phone:
Fax number:
Relationship to you:

Reference 3

Name:
Street Address:
City: State: Zip:
Home Phone: Work Phone:
Fax number:
Relationship to you:


19. Please write anything else that would be helpful for us to know about you:


20. Are you able to transport youth in your automobile for off-site activities?  Yes   No

Transporting Children in your car is required for mentors, and optional for tutors and other volunteers.  If you are interesting in
becoming a mentor, or are willing to use your personal vehicle and insurance in transporting children to and from tutoring and other activities, please complete the following information:

Number of passenger seats with seatbelts in your vehicle:
Do you have at least the required minimum liability insurance on your vehicle? Yes   No
Name of your insurance company:
Insurance policy number:
Driver's license number and state (not your car license plates):
You will need to provide a copy of your driver's license and insurance verification.

By clicking the Send button below to submit this volunteer application, you authorize the release of your
criminal history and records to the Family Learning Center through the Central Registry, motor vehicle records, police background check and reference checks.

A staff member will contact you after this application has been received.

It may take a few minutes to submit the form. Please wait for a "Thank You" message to appear. Otherwise the information will not be received. Please be patience.

Back to top
3164 34th Street, Boulder, Colorado 80301
(303)442-8979 Fax (303)442-0901
Email address: info@flcboulder.org