VOLUNTEER > APPLICATION


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(*) mandatory fields
* Name:
* Home Address:
 
* Telephone:
Home
Work
Pager/Cell
* Email:
* Social Security / /
* Company Name
 
The following information is used only to determine diversity of Street Tech mentors/volunteers. Completion is optional. (Please check one)
American (not Hispanic)      Caucasian (not Hispanic)
Hispanic     Asian or Pacific Islander     American Indian
Other:
Age:
Are you a student?
Full Time    Part Time    No
Is it necessary to limit your physical activity in any way? If yes, what is your limitation or challenge?
Are you a licensed driver?
Yes    No
Do you have a car?
Yes    No
List previous mentoring or volunteer experiences (volunteer, paid, or educational) that would be helpful in working with young adults and/or technology.
Activity
Organisation
Date
List any skills, hobbies, or interests you have that might be helpful in volunteering for Street Tech:
Are you able to fluently speak, read or write any language other than English?
How many hours a week and on what days are you available to mentor/volunteer?
Are you available for weekly face to face visits with your mentee/student or do you prefer to be in contact by phone and/or Email?
Available for visits
Available by phone
Available by Email
Individual to be notified in case of Emergency:
Name
Relationship
Address
 
Tel No.
 
       
 
 
 
For further information contact Joe McKinley at (510) 234-1300 ext. 1# for more information

 

 
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