2. 
4. Name:*
5. Email:*
7. Address:*
8. Date of Birth:*
10. City, State:*
11. Zip Code:*
13. Place of Employment:*
14. Phone 1:*
16. Job Title:*
17. Phone 2:
21. The following information is for statistical purposes. Please check the appropriate boxes.
23. SEX*

    1. Male
    2. Female
24. RACE*

    1. American Indian
    2. Asian
    3. Black
    4. Latino
    5. White
    6. Other
25. EDUCATION*

    1. K - 12
    2. H.S. Diploma
    3. Some college
    4. Undergraduate Degree
    5. Graduate
26. EMPLOYMENT*

    1. Employed
    2. Unemployed
    3. Retired
    4. Student
29. Degree/Field:
32. Country Received:
36. How did you hear about us?*
38. What is your native language?*
39. Check all that apply:*

    1. speak?
    2. read?
    3. write?
41. What is your second language?*
42. Check all that apply:*

    1. speak?
    2. read?
    3. write?
44. Other language(s)?
45. Check all that apply:

    1. speak?
    2. read?
    3. write?
49. AVAILABILITY
51. Anytime:*

    1. Yes

    1. No
53. Check boxes of days & times you are available.
55.                                       Mornings                       Afternoons                      Evenings
57. 
    
    Mon.
58. Check all that apply:

    1. Mon. Mornings

    1. Mon. Afternoons

    1. Mon. Afternoons
60. 
    
    Tues.
61. Check all that apply:

    1. Tues. Mornings

    1. Tues. Afternoons

    1. Tues. Evenings
63. 
    
    Wed.
64. Check all that apply:

    1. Wed. Morning

    1. Wed. Afternoons

    1. Wed. Evenings
66. 
    
    Thurs.
67. Check all that apply:

    1. Thurs. Mornings

    1. Thurs. Afternoons

    1. Thurs. Evenings
69. 
    
    Fri.
70. Check all that apply:

    1. Fri. Mornings

    1. Fri. Afternoons

    1. Fri. Evenings
72. 
    
    Sat.
73. Check all that apply:

    1. Sat. Mornings

    1. Sat. Afternoons

    1. Sat. Evenings
75. I can commit to:*

    1. 1 Year

    1. 2 - 3 Years

    1. 3 - 5 Years
79. I prefer volunteering at the following GNLV location:*

    1. Norwalk Public Library Main Library
    2. Norwalk United Methodist Church

    1. Norwalk Public Library SoNo Branch
    2. No Preference
83. Why are you interested in working with Greater Norwalk Literacy Volunteers?*
85. Teaching/Tutor Experience:*
87. Volunteer experience:*
89. List special skill/abilities or special interests that you are willing to offer Literacy Volunteers
    (e.g. graphic design, party/special event planning, etc.) if needed:*
91. Do you have physical, mental or medical disabilities that would interfere with your ability to perform your duties with Greater Norwalk Literacy Volunteers?*

    1. Yes

    1. No
93. If yes, explain:
95. Have you ever been convicted of a crime other than a misdemeanor?*

    1. Yes
    2. No
97. If yes, date and charge:
101. PROFESSIONAL REFERENCES: Provide work/volunteer references who are not relatives.
103. NAME
104. RELATIONSHIP
105. PHONE
107. 1.*
108. 1.*
109. 1.*
111. ADDRESS:*
113. 2.*
114. 2.*
115. 2.*
117. ADDRESS:*
121. EMERGENCY CONTACT:
123. Name*
124. Relationship to you:*
125. Phone:*
129. Applicant's Statement:
     I understand that the information given on this application is subject to review and that incorrect or misleading information renders this application void. I understand that Greater Norwalk Literacy Volunteers at Norwalk Public Library reserves the right to accept or reject applicants.
131. Signature:*
132. Date:*
     Date:
Leave This Blank:


135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit Submit and Print

* indicates a required field