Volunteer Application

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

Gender

Male

Female

Other

Race

Asian

Black

Hispanic/Latino

Native American

White

Other

Days Available *

Monday

Tuesday

Wednesday

Thursday

Friday

Time Available *

*Note, most opportunities are available in the mornings or evenings.

Mornings

Afternoons

Evenings

Have you ever been convicted of a crime other than a misdemeanor?

Yes

No

Emergency Contact

Please provide an emergency contact if possible.

First Name

Last Name

Phone

(###)

###

####

Signature *

I understand that the information on this application is subject to verification. I agree that if accepted as a volunteer, I will abide by the volunteer regulations as outlined by Literacy Volunteers of Greater Hartford.

First Name

Last Name

Date *

MM

DD

YYYY