Tutor Registration form

Our office hours are 8:30 a.m. to 4:30 p.m. Monday through Thursday 8:30 a.m. to 3:00 p.m. on Fridays
Phone - 407-422-1540
Fax - 407-422-1529

Desired Username: Password: Re-Type Password: Date: 8/20/2008 *Last Name: *First Name: MI: *Address: *City: *State: *Zip: Home Phone: *e-mail: Occupation: Employer: *Work Phone: Cell Phone: Fax: Work e-mail: I prefer to be called: at work at home How did you find out about our program? Newspaper, radio, TV, PSA Handout, mailing, brochure Sign, billboard, other ad Phonebook/Yellow Pages Relative, friend, associate Employer School/institution/library Agency/United Way Church Adult Literacy speaker Dollar General Adult Literacy poster Internet Tutoring Sites Check every possible convenient location - we can assign you more quickly if you are flexible! Orange County Adult Literacy League Office Alafaya Library (E. Colonial) Edgewater Library (Northgate Plaza) First Bapt. Church of Orlando First Presbyterian Church (after 9/2000) Herndon Library (E. Colonial) Hiawassee Library Maitland Public Library North Orange Library (Apopka) Oak Ridge H.S./Community School Orlando Public Library (Central Blvd.) Orlando Tech St. Pauls Presbyterian Church in Ocoee South Orange Library (Waterbridge) South Trail Library (Orange Blos. Center) Southeast Library (Hoffner Center) Southwest Library (Dr. Phillips) Washington Park Library (Raleigh) W. Orange Library (Winter Garden) Windermere Library Winter Park Library Osceola County Buenaventura Lakes Library (Kissimmee) Central Library (Kissimmee) Kenansville Library (Kissimmee) Poinciana Library (Kissimmee) St. Cloud Library (Kissimmee) Seminole County Altamonte Springs City Library Central Branch Library (Casselberry) East Branch Library (Oviedo) North Branch Library (Sanford) Northwest Branch Library (Lake Mary) West Branch Library (Hunt Club Blvd.) Other Worksite Please provide as many choices as you can for days & times when you can tutor: Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Afternoon Evening Remember! If you can meet more than one day a week your student will progress more quickly! Would you work with a student who is: On probation In drug rehabilitation Demographic Information (Required for our funders & partners) *Date of Birth: *Gender Male Female *Ethnicity: African American Asian Hispanic White Other *Education: High School/GED Some College Associates Degree Bachelors Degree Graduate School Field of Study: Other Languages: Other School/Certificates: *Marital Status: Married Single Divorced Widowed Name of Spouse: Other Ways to Volunteer: Office/administrative Computers/data entry Training new tutors Special Events Community Relations Program Development/Cirriculum/Assessment Board Service Student Involvement Community/Volunteer recruitment fairs Fundraising Public Speaking Would you be willing to... Share the name of your church/faith affiliation? Contact Name & Phone: Could they provide tutoring space free of charge? No Yes Could your place of business provide tutoring space? No Yes *Why do you wish to be a literacy volunteer?     Learning to read takes time so we ask for a one-year commitment from both you and your student. If the cost of purchasing the tutor's manual(s) is prohibitive, we will gladly provide a scholarship. SAFETY is ALL our business. Meet your student at the library or a mutually agreed-upon, public location approved by the Programs Coordinator. Never tutor at your home!