Volunteer Registration Form Step 1 of 4 0% Name* First Last Home Address*City | State | Zip Code*Phone*Do you prefer text messages?YesNoEmail* Date of Birth OccupationIf Student, School Name:Graduation Year:Additional InformationSource of referral to volunteer with CLASP:Do you have teaching experience or other experience working with children (not required): Placement InformationPreferred tutoring method In person Online Either in person or online (Please check all that apply)Preferred grade level to tutor:1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeAny GradeWill you need transportation to the program site?YesNoCan you provide transportation for others to the program site?YesNoI have the results of a negative TB test (taken with the last 4 years) and will submit paperwork to CLASP. Yes No Emergency Contact InformationName First Last RelationshipPrimary PhoneOther Phone Background InformationHave you ever been convicted of a crime (felony or misdemeanor) other than a traffic violation? Yes No Has a civil or criminal complaint ever been filed against you that alleged misconduct or child abuse by you or your participation in or facilitation of such activities? Yes No Have you ever chosen not to renew or continue any employment or volunteer service, had your employment or volunteer service terminated, or been subject to any internal disciplinary action relating to allegations of any misconduct or child abuse by you? Yes No If YES to above | Upload File:If YES to any above, please attach a separate sheet of paper explaining the nature, date, and place of conviction Please Read Carefully• The information contained in this application is true and correct to the best of my knowledge. • I understand that CLASP will conduct background checks on me, including criminal activity checks, and I consent to whatever background checks CLASP considers necessary. • I understand and authorize any references, or any other person or organization, whether or not identified in this application, to give any information (including opinions) regarding my character and fitness for service. • I hereby release any reference contact, whether identified or not in this application, and waive any and all claims, liability for damages of whatever kind or nature which may at any time result to me, my heirs/family, on account of compliance with this authorization, excepting only the communication of knowingly false information. • I am aware that background checks may be performed periodically. Signature*By typing my name here, I verify the information contained in this application is true and correct to the best of my knowledge, and that this serves as my signature: *Date* Date of Signature ( * ) = Required
