Name
Address
City, State, Zip	WA,
Date
Home Phone
Work Phone
E-mail Address

Which of the following volunteer opportunities interests you?

ESL Classroom Assistant (working with adults)
ESL Small Group Teacher (working with adults)
Childcare Assistant (working with preschoolers)
Bilingual Assistant (working with adults or children)
Teaching Assistant (working with school-aged children)
Office Support
Computer Support
Fundraising
Other (please specify)
Please specify

Why do you want to volunteer at ReWA?

Please describe any teaching/tutoring experience you have had.

What other skills or experiences do you possess that might be useful as a ReWA volunteer?

Languages spoken or studied .

Availability:

Days/times during the week:

Monday		Times
Tuesday		Times
Wednesday		Times
Thursday		Times
Friday		Times
Number of hours per week
Minimum time commitment in number of months

Have you had any ESL training?  When and where?

Have you ever been convicted of a crime? Explain.

References:  Please list two references (Prefer at least one to be employment/education/volunteer-related.)

Name	Title	Phone Number

Volunteer Profile

Gender

Female

Male

Education Completed

	Grade 9-11		High School. Diploma		GED
	Some College		2-year Degree		4-year Degree
	Graduate Degree

Employment Status

	Student		Employed
	Unemployed, Seeking Work		Not Seeking Work
Profession/Occupation

Referral Source

	Court/Probation		Employer/School
	Library		Newspaper
	Poster/Sign/Flyer		TV/ Radio
	WA State Literacy Hotline		Other Literacy Program
	Word-of-mouth		Other (Please describe)

Peace Corps. (or other volunteer corps.)

	Peace Corps. experience
	Experience in any other volunteer corps.
	Name of other volunteer corps.
	Position
	Dates of service	Start:	End: