CATHOLIC CHARITIES HOGAR HISPANO

Volunteer Application

I. CONTACT INFORMATION

Name:__________________________________________________ Email:__________________________________

Mr./Mrs./Ms. First Last

Address:__________________________________________________________________________________

Street City, State Zip

Telephone:_________________________ _________________________ Birthdate:________________

Home Work/Cellular Day/Month/Year

Emergency Contact:_________________________________________________________________________

Name Evening Phone Daytime Phone Relationship

II. BACKGROUND AND SKILLS

Please list any academic organizations, professional organizations, service organizations, clubs, faith communities, churches, synagogues, or mosques to which you belong:

Please list any agencies and organizations for whom you have volunteered (past/present):

What are your professional and academic talents?

Please describe your level of computer literacy and any proficiency in foreign languages:

What do you hope to gain by volunteering with Hogar Hispano?

III. PROFESSIONAL AND PERSONAL REFERENCES

Current Employer or Academic Institution:____________________________________________________

School/Agency/Business/Organization City

Job Title/Course of Study:___________________________________________________________________

1. Current Supervisor/Academic Advisor:

Mr./Mrs./Ms. First Name Last Name Telephone Email

2. Professional/Academic Reference:

Mr./Mrs./Ms. First Name Last Name Telephone Email Relationship

3. Personal Reference:

Mr./Mrs./Ms. First Name Last Name Telephone Email Relationship

III. INTERESTS AND AVAILABILITY

Please indicate how you would like to serve immigrants in our community:

□ English as a Second Language Site (ESL) Coordinator □ Teen Tutor □ Office and Administrative Assistant

□ ESL Teacher □ Technology Aide □ Job Development Assistant

□ Teaching Assistant □ Substitute Teacher □ Social Services/Information & Referral

□ Citizenship Workshop Volunteer □ Legal Assistant □ I have a special skill to share:

__________________________________

Please indicate when and where you are available to volunteer:

□ Alexandria □ Arlington □ Dale City □ Dumfries □ Fairfax □ Burke

□ Falls Church □ Manassas □ Reston □ Sterling □ Vienna □ Woodbridge

IV. SIGNATURE

In signing and completing this volunteer application, I:

· authorize Hogar Hispano staff to contact the references I have provided above in regards to this volunteer position.

· understand that Hogar Hispano’s staff and students expect site coordinators and teachers to serve for one academic year.

· agree to attend a minimum of 12 hours of teacher training.

· certify that the information provided on this application is true and accurate.

______________________________________________ ________________

Signature Date

Thank you for your interest in serving others with Catholic Charities Hogar Hispano!

Please print this form, complete it, and mail it to:

Amy White ♦ ESL Program Coordinator ♦ Catholic Charities Hogar Hispano

6201 Leesburg Pike ♦ Falls Church, Virginia 22044 ♦ 703-534-9805 x238 ♦ Fax: 703-534-9809