Everybody Wins! Volunteer Application

Date

First Name

Last Name

Company/Organization

Company/ Organization Street Address

Company/ Organization Zip Code

Job Title

Department

Daytime Phone

Primary E-mail

Cell Phone

Only to be used, if necessary, to contact you on your reading day.

Home Street Address

Home Zip Code

Home Phone

Gender

optional

female male

Race/ Ethnicity

optional

Black/ African American Latino/ Hispanic White/ NonHispanic Asian/ Pacific Islander Other

Age

optional

under 25 25-35 36-45 46-55 over 55

Education

Check highest degree

High School Undergraduate Graduate Other

Major Area of Study

Reading Location

Please select your preferred reading location

Reading Day- 1st Choice

Reading Day- 2nd Choice

Would you like to alternate with another volunteer?

yes no

If yes, please provide Name and E-mail Address

Have you received Act 33/34 Clearances in the past 2 years?

Maiden Name/ Aliases

Social Security #

References

Please provide the name, relationship, phone, and e-mail for TWO business or personal references.

Why do you want to be a volunteer reader?

How do you think Everybody Wins! can benefit a child?

How did you hear about Everybody Wins! Power Lunch?