Annual Vintner Dinner
Children’s Literacy Circle
Volunteer to Tutor
CLC’s Wonderful Sponsors
Events & Happenings
Annual Report 2016
Part I - General Information
Date of Birth
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
How did you hear about Children's Literacy Center?
Board of Directors Reference
Print Ad or Flyer
TV or Radio Publicity
Word of Mouth
Part II - Limitations & Emergency Information
This information is kept confidential and is only for Children’s Literacy Center’s use.
Do you have any physical or health conditions that may limit your participation?
Part III - Education/Training/Volunteer Experience/Special Skills
What is the highest level of education you have completed?
Graduate or Professional Degree
If you are currently a student, what school do you attend?
If you are a college student, do you receive work study as part of your financial aid package?
Are you being required to perform community service?
Reason for community service:
School or honors program requirement.
Please explain. Include number of hours needed and deadline for completion.
Do you speak another language fluently?
What other language do you speak?
Please list your most recent volunteer experience.
Part IV - Tutoring Sites
Select the top two choices from the list of tutoring sites at which you would like to tutor. See the View locations and times link, below, for more information regarding avalible times and dates.
Banning Lewis Ranch Academy
Barnes & Noble - Citadel
Fountain Valley YMCA
MLK Library – Aurora
Z Place-Evie Dennis Campus
Which semester do you prefer to start?
Fall (mid-September through mid-December)
Spring (February through May)
Summer (late-June through early-August)
Would you prefer to complete your training online or in person?
In Person Training
Part V - Background and Authorizations
Have you ever been charged with, arrested for, convicted of, pled no contest to, or received a deferred sentence or deferred prosecution for a felony or a misdemeanor crime (other than minor traffic offenses)?
If yes, please describe.
I do hereby proclaim that I have never been convicted of or reported for abuse, neglect, sexual assault, or a related charge, against a child, as defined in the Colorado Revised Statutes. Furthermore, I am aware of the Colorado Revised Statute which states that intentionally/willfully placing a child in a position of danger, with intent to commit harm to said child, or placing child in a position of mistrust to include any sexual misconduct with a child, is punishable by law. I also understand that the Children's Literacy Center staff is required to report any such misconduct to the proper authorities. Such misconduct will be grounds for immediate suspension and possible prosecution and termination.
Yes, I give permission to Children's Literacy Center to include my name and picture in any of their publications.
No, please do not publish my name or picture.
Throughout the year, Children's Literacy Center and local media publishes pictures and accounts of the activities and accomplishments of our students and volunteers. We would like to be able to include your picture in our media, but we also want to be sensitive to your privacy. Please indicate above if you give Children's Literacy Center permission to take your picture and include it and your name in any of our media.
Release of Information
The information in my application is true and complete to the best of my knowledge. I understand that it is necessary for Children's Literacy Center to investigate my background. I hereby give my consent for this information exchange and authorize such agencies or individuals to release any information requested. I understand the agencies to be contacted shall include employers, police (local, state or federal), Social Services and any other persons or agencies with which I have any interaction.
By submitting this form, I attest that the information I have provided on the form is true and accurate. I understand that an offer of volunteer work may be rescinded either before or after my date of assignment pending results received from my background check.