Volunteer Registration Form
Contact Information
First Name
Middle Name
Last Name
Mobile
Home Phone
Work Phone
Birthdate (Must be 18yrs old to volunteer)
Race/Ethnicity
Please select...
African American/Black
Asian/Pacific American
Caucasian
Hispanic/Latino
Native American
Two or More Races
Other
Prefer not to say
Gender
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Male
Female
Other
How did you hear about Literacy Achieves?
Please select...
Friend or family member
Internet search / volunteer website
Association (e.g. Northwood, Junior League, NCJW)
Faith community / church / synagogue
Newspaper / news article / newsletter / magazine
Other
Email
Mailing Street
Mailing City
Mailing State/Province
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Mailing Zip/Postal Code
Volunteer Information
Marital Status
Please select...
Single
Married
Widowed
Separated
Divorced
N/A or prefer not to answer
Spouse Name (if married)
Why do you want to volunteer at Literacy Achieves?
Volunteer Availability and Skills
Campus
Please select...
ELM (East Dallas)
VM (Vickery Meadow)
Online
Time of Day
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Morning
Afternoon
Morning
Afternoon
Night
Morning
Afternoon
Night
Days of Week
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Monday
Tuesday
Wednesday
Thursday
College(s)
Degree(s)
Past or Current Volunteer Experience
Please list any community affiliations (faith community, sorority, club, league, etc.)
Special skills (areas of expertise, hobbies, etc.)
Emergency Contact Info
Emergency Contact Name
Relationship
Phone/ Mobile xxx-xxx-xxxx
Reference Contact Info
Reference Name (Cannot be a relative)
Reference Relationship
Reference Phone Number
Volunteer Reference Email
Contact Information