Volunteer Tutor Application Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide at least one phone number below:(Required) Cell Phone Home Phone Work Phone Cell Phone(Required)Home Phone(Required)Work Phone(Required)Would you like to receive text messages regarding the status of your application? Yes, I would like to receive text messages regarding the status of my application. By selecting yes, you agree to receive text messages from Dyslexia Tutoring Program related to tutoring services. Message & data rates may apply. Message frequency varies. Reply HELP for help and STOP to cancel.Email(Required) Birthdate(Required) MM slash DD slash YYYY Are you currently working?(Required) Yes No Are you currently in school?(Required) Yes No Are you retired?(Required) Yes No What is your occupation?(Required)For how long (years)?(Required)How did you hear about Dyslexia Tutoring Program?(Required)Select OneWYPR/WYPF/WYPO/NPRShine FM RadioBright FM RadioDTP TutorFriend/Coworker/NeighborVolunteer WebsiteCommunity EventSenior CenterSchool/TeacherPublic LibraryGoogleOnline AdFlyer / BulletinOtherPlease specify how you heard about us:(Required)Why do you want to become a volunteer tutor?(Required)What is your highest level of education?(first entry is required; entry 2 and 3 are optional)Entry 1 - School(Required)Degree(Required)High School Diploma / GEDAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree / PHD / JD / MDProfessional CertificationsYear Graduated(Required)Entry 2 - SchoolDegreeHigh School Diploma / GEDAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree / PHD / JD / MDProfessional CertificationsYear GraduatedEntry 3 - SchoolDegreeHigh School Diploma / GEDAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree / PHD / JD / MDProfessional CertificationsYear GraduatedList any employment/volunteer experiences that would help you as a volunteer tutor.Entry 1 - OrganizationContactPhone/EmailEntry 2 - OrganizationContactPhone/EmailEntry 3 - OrganizationContactPhone/EmailHave you ever been convicted of a felony or misdemeanor?(Required) Yes No A BACKGROUND CHECK IS REQUIRED FOR EVERY APPLICANTI consent to DTP conducting a background check as a condition of becoming a volunteer tutor.(Required) Yes No Please provide names and contact information for at least two (2) references who can speak about you regarding a volunteer tutoring role.Reference 1 - Name(Required) First Last Email(Required) Relationship(Required)Reference 2 - Name(Required) First Last Email(Required) Relationship(Required)Reference 3 - Name First Last Email RelationshipI certify that the information given by me in this application is true in all respects, and I agree that if I am accepted as a volunteer by Dyslexia Tutoring Program and this information is found to be false in any way that I may be subject to termination from Dyslexia Tutoring Program. I understand that completion of this application is not a guarantee of acceptance as a volunteer with Dyslexia Tutoring Program. I further agree that if I take the training class and fail to fulfill my commitment to tutor a client in the Dyslexia Tutoring Program for 60 hours, I am responsible for reimbursing Dyslexia Tutoring Program $500 for the cost of the class, to be prorated based on the number of hours I actually tutored, as well as the return of all class materials.By typing my name below, I acknowledge it serves as my legal electronic signature.(Required) Yes, I acknowledge it serves as my legal electronic signature. Signature(Required) First Last Date(Required) MM slash DD slash YYYY CAPTCHA
