Mr. Ms.

Name:

E-mail address (required):

Date of Birth (required):

Address:
City, State, ZIP:

Phone (work):
Phone (home):

Education. Please tell us about your educational background or special knowledge or skills:

Current Employer:

Current Occupation:

Languages Spoken (other than English):

Preference Information

Grade Level Preferred (can check more than one):

K-3
4-6
7-8
9-12
Administrative

Gender Preferred:

Male
Female
No Preferrence

Schools Preferred (can check more than one)

CISNT Central Office, Lewisville
Denton ISD (any school served by CISNT in this district)
Borman Elementary School, Denton
Calhoun Middle School, Denton
Denton High School, Denton
Rivera Elementary School, Denton
Lewisville ISD (any school served by CISNT in this district)
Central Elementary School, Lewisville
Delay Middle School, Lewisville
Griffin Middle School, The Colony
Hedrick Elementary School, Lewisville
Hedrick Middle School, Lewisville
Lakeland Elementary School, Lewisville
Peters Colony Elementary School, The Colony
TARMAC, Lewisville
Little Elm ISD (any school served by CISNT in this district)
Brent Intermediate School, Little Elm
Lakeside Junior High School, Little Elm
Little Elm High School, Little Elm
Powell Intermediate School, Little Elm
Northwest ISD (any school served by CISNT in this district)
Chisholm Trail Middle School, Rhome
Northwest High School, Justin
Prairie View Elementary School, Rhome
Roanoke Elementary School, Roanoke
Seven Hills Elementary School, Newark

Days and Hours Available Each Week (click on checkbox and enter the time available):

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

If you know which volunteer role you are seeking with CISNT, please check below (can check more than one):
School Day Mentor (8 am - 3 pm, M-F)
School Day Tutor (8 am - 3 pm, M-F)
Learning Beyond the Bell (3 pm - 6 pm, M-F, Central Elem, Hedrick Elem, Lakeland Elem, Peters Colony Elem, Lewisville ISD)
Learning Beyond the Bell (4 pm - 6 pm, M-F, DeLay Middle, Lewisville ISD)
Breakfast Buddies (7:30 - 8:00 am, Friday, Central Elementary, Lewisville ISD)
Saturday Connections (9-11 am, Saturdays)
Special Event (i.e. career day, health fair, etc)

Please describe your qualifications for this volunteer position:

How did you hear about CISNT?:

Are you volunteering to fulfill a college class requirement? If yes, for what program?

Social Work
PRAXIS
Rehabilitation
Other, please specify

How many hours do you need to complete to fulfill your requirement?

Person To Be Notified In Case of Emergency

Name:

Phone Number:

2nd Phone Number:

Have you Volunteered Before? If Yes, Where?

Please List Three Character References:

All mentors and tutors are asked to complete an additional survey and attend an orientation session prior to meeting with a student. Please click here to download the Criminal Background Check Form (right click, save as). Click here to download the Mentor Survey (right click, save as).

All applicants must read and sign the following statement:

VOLUNTEER CONFIDENTIALITY AGREEMENT

Volunteers will, to the best of their ability, ensure confidentiality and privacy in regard to history, records, and the services provided to students and family members of Communities In schools of North Texas. All participation regarding services received in the CISNT program will be kept confidential. Disclosure can be made only under specific conditions including any situation in which the student or another individual is in danger of receiving bodily harm. I have read the above information regarding CISNT policy on the subject of participant confidentiality. I agree to respect the policy and maintain the privacy of the individuals served in the CISNT program.

Completing the signature and date field serves as your signature to this agreement.

Signature of Volunteer:

Date of Signature: