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Request Information

(239) 262-4448
8833 Tamiami Trail East,
Naples, FL 34113

We teach English as a second language to families and individuals; both adults and children!

 

I want to be a Volunteer with LVCC!

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Complete Your Registration Form for Volunteering.
Click “Submit” several times (bottom of form.)



VOLUNTEER REGISTRATION
FIRST NAME *
MIDDLE-NAME
LAST NAME *
GENDER MaleFemale

ADDRESS
CITY
STATE
ZIP CODE

HOME PHONE
CELL
EMERGENCY CONTACT
EMERGENCY PHONE
EMAIL *
PLACE OF BIRTH
DATE OF BIRTH
RESIDENCY Full-TimePart-Time

EDUCATION High School DiplomaSome CollegeUndergraduate DegreeGraduate DegreeOther Education

FIRST LANGUAGE
ADDITIONAL LANGUAGES
CURRENT EMPLOYMENT STATUS Full TimePart TimeRetired

OCCUPATION (Current / Former)
HAVE YOU EVER BEEN CONVICTED YesNo


CHOOSE VOLUNTEER DAYS
What days are you able to volunteer? (Be Specific)

What times?____________________

MONDAY MorningAfternoonEvening
TUESDAY MorningAfternoonEvening
WEDNESDAY MorningAfternoonEvening
THURSDAY MorningAfternoonEvening

What volunteering role do you prefer?AmbassadorNewsletterSocial MediaFund RaisingMailingsSpecial EventsWebsiteMarketingComputer LabWorkshop AssistanceOther (please specify)____________


Would you be willing to be a substitute volunteer?yes


CHARACTER REFERENCES

FIRST REFERENCE
1st Reference NAME:
1st Reference ADDRESS:
1st Reference PHONE:
1st Reference E-MAIL (optional):

SECOND REFERENCE
2nd Reference NAME:
2nd Reference Address:
2nd Reference Phone:
2nd Reference E-Mail (optional):

THIRD REFERENCE
3rd Reference NAME:
3rd Reference Address:
3rd Reference Phone:
3rd Reference E-Mail (optional):


CONFIDENTIALITY

1.Never give out personal information about a tutor, student, or volunteer.

2.Refer any request of information relating to LVCC tutors, students, or volunteers to the appropriate staff member.

3.Personal information about a tutor, student, or volunteer should only be shared on a need to know basis.

As a tutor/student/volunteer for LVCC, I understand in the course of my service, I may learn information about students, tutors, volunteers, or staff which is confidential: e.g. finances, living arrangements. I understand all such information shall be treated as completely confidential even after I terminate my services with LVCC.
I agree not to disclose any information of a personal and /or confidential nature to any person not authorized by LVCC to have such information, without specific consent of the individual to whom such information pertains. Failure to comply with this Confidentiality Agreement will result in release from affiliation with LVCC.

INITIALS*

TUTOR STATEMENT OF INTENT

As a LVCC tutor, I agree to do my best to carry out the following tutor responsibilities:

1.Begin or schedule tutoring within a month after completion of training;

2.Donate a minimum of a year to tutoring;

3.Maintain confidentiality;

4.Respect students’ rights and understand their responsibilities;

5.Promptly complete and return quarterly tutor hours and student progress reports.

When possible, attend in-service training workshops and roundtables, and if for some reason I am not going to be able to carry out my responsibilities as a LVCC tutor, I will let the LVCC Office know and I will return the materials that were distributed to me, so that other tutors can benefit from them. I have read and understand the responsibilities expected of me as a representative of LVCC.

INITIALS*

PERSONAL RELEASE AGREEMENT

For good and valuable consideration, receipt of which is hereby acknowledged, I irrevocably grant to LVCC and its assigns, licensees and successors, the right to use my image and name in all forms and all media including composite or modified representations for all purposes, including advertising, trade or any commercial purposes throughout the world and in perpetuity. I waive the right to inspect or approve any versions of my image used for publication or the written copy that may be used in connection with said images. I release LVCC and its assigns, licensees and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, and/or rights of publicity or copyright. LVCC is permitted, although not obligated, to include my name as a credit in connection with said image. LVCC is not obligated to utilize any of the rights granted by this Agreement. I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

INITIALS*

RELEASE OF LIABILITY

FOR GOOD AND VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, the undersigned does hereby release LVCC, its licensees, successors, or assigns for any breach of said organization’s written or unwritten policies regarding performance of the undersigned’s duties as a literacy volunteer/tutor, or actions or activities made or performed by the undersigned while performing those duties as a literacy volunteer/tutor or ancillary thereto. It is the stated intention of the undersigned to fully RELEASE the Literacy Volunteers of Collier County to the fullest extent possible, from any and all liability which could arise as a result of the undersigned’s association with said organization, including but not limited to any legal actions, either criminal or civil, and agrees to indemnify and hold harmless the LVCC from any such liability. I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

FIRST & LAST NAME *
DATE*


SIGNATURE*

Your information will never be shared with any third party.

Address

8833 Tamiami Trail East, Naples, FL 34113

Phone

(239) 262-4448
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