If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required CONTACT INFORMATION Name (Last, First, Middle Initial) * Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Birthdate * Email * Home Phone * Cell Phone * Work Phone Preferred Method of Communication Gender Male Female How did you hear about the program? EXPERIENCE List organizations you’ve volunteered with and the type of volunteer work you’ve done List experiences you’ve had working with children Describe any experience you’ve had working with children/youth in foster care Describe any experience you’ve had as a tutor Have you ever been convicted of a misdemeanor or felony? YesNo PREFERENCES I prefer working with children in (check all that apply): Pre-KElementaryMiddle SchoolHigh School Subjects I prefer are (check all that apply): ReadingMathLanguage ArtsSocial StudiesScienceLEAP (4th Grade)LEAP (8th Grade)ACT PrepGED Prep Please List any degree or certification you hold: IN CASE OF EMERGENCY NOTIFY Name Relationship Phone TERMS OF AGREEMENT Please check each of the following: I agree to follow all policies and procedures. I understand that my volunteer participation is at will, that the terms and conditions of my volunteering can be changed at the option of Crossroads NOLA and that my volunteering can be terminated at any time at the option of Crossroads NOLA or myself and/or DCFS. I understand that Crossroads NOLA and/or DCFS is not obligated to assign or actively seek to assign me to a volunteer activity or position. I understand that Crossroads NOLA and/or DCFS is not obligated to provide a reason for their decision to accpet or decline my volunteer application.(Optional) I agree to allow Crossroads NOLA and or/DCFS to use any photographic image of me taken while participating as a volunteer. These images may be used in promotions or other related marketing materials. I understand that I must return the following completed items to Crossroads NOLA and that any incomplete information will result in the delay of my application being processed: Volunteer Application and Interest Form$13.00 payable to Crossroads NOLA to offset cost of my finger print and background check I understand that full processing of my application includes an application, training and criminal records check with applicable govermental agencies. By submitting this form, I declare that all of the information in this application is true, complete and correct to the best of my knowledge.