Volunteer Application -- Communities In Schools of North Texas, Inc.

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Volunteer Application

Thank you for taking a few moments to apply to become a volunteer with Communities In Schools of North Texas. The gift of time is one of the greatest gifts you can provide to us. As you begin your journey by completing this brief volunteer application, please realize that we commit to stand by you and do everything possible to make your volunteer experience with Communities In Schools of North Texas rewarding.

There are six primary steps in your application to become a Communities In Schools of North Texas volunteer.

Sincerely,
Gary Henderson
Chief Executive Officer - Communities In Schools of North Texas

Note: Please use the TAB key or click in the respective form boxes to navigate the fields. Do not hit ENTER until you have completely finished filling out the application. Pressing the enter key automatically submits the application.

Personal Information
Title:

First Name:

Last Name:

Email Address:

Email Type:

Work e-mail
Home e-mail

Contact Information

Phone:

Phone Type:
Home phone
Cell phone
Work phone

Street Address

Building or Apartment #

City

State

Zip Code

Is this address your home, work or work mail address?

Home address

Work Address

Work Mail Address

Please Select That Which Best Describes Your Current Employment Status

Company Name (if applicable)

Job Position (if applicable)

Date of Birth

Month

Day

Year

Gender

Marital Status (optional)

Ethnic Origin (optional)

Level of Education Completed (optional)

Check All Languages That You Speak (optional)

English
Spanish

Chinese
Portugese

Vietnamese
Japanese

Burmese
Tagalog
Other

Please Tell Us About Your Volunteer Interests (check all that apply)

School-based Mentor or Tutor
Special School Event Volunteer
CISNT Advisory Council
CISNT Technology
CISNT Fundraising (events, grants research)

e-Mentor
Administrative Support
CISNT Board of Directors
CISNT Marketing/Public Relations
Other

Are You Volunteering to Fulfill a Class or Club Requirement?

To help us make the best match possible for you and the student you will be mentoring, please tell us your hobbies and interests.

Please provide two non-family references that we may contact to learn more about you. Feel free to let these references know about Communities In Schools of North Texas and your interest in being a Communities In Schools of North Texas volunteer.

Name

e-Mail Address

Phone

In the unlikely event of an emergency, please provide:

First Name

Last Name

Relationship

Home Phone

Cell Phone

Work Phone

At which Independent School District are you most interested in volunteering?

Denton ISD

Lewisville ISD

Little Elm ISD

Northwest ISD

or Communities In Schools of North Texas Central Office

I am most interested helping Communities In Schools of North Texas at-risk students at the following grade levels
Elementary School (Pre-K through 5th Grade)
Middle School (6th Grade through 8th Grade)
High School (9th Grade through 12th Grade)
Please place me in the grade level where I am most needed
I prefer a volunteer role not directly working with children

What are the most convenient times for you to help a student? Please check all that apply.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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Protecting Our Students

Some of the questions below may seem personal, but they are important to ask when considering the relationship that will build between a mentor and their student. Communities In Schools of North Texas will keep all information that you are providing in this application confidential.

Are you available to meet with a CISNT student for an hour each week during the school year?

Have you ever been arrested or convicted of a crime, child abuse/neglect, or of sexually abusing or molesting a youth 18 or younger?

Are you willing to communicate regularly and openly with CISNT staff, share monthly information regarding your volunteer activities, and receive feedback regarding any difficulties during your participation in the volunteer program?

I agree to allow Communities In Schools of North Texas to use any photographic or video image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials. (OPTIONAL: not a condition of serving as a CISNT volunteer)

VOLUNTEER CERTIFICATIONS AND AGREEMENT- Please read this carefully before checking the boxes below:

Communities In Schools of North Texas appreciates your interest in donating time as a volunteer to help kids succeed. In order to continue to achieve the outstanding results our program has produced since 1994, we respectfully request that you take this volunteer position as seriously as any effort you would be financially compensated for by agreeing to the following:

Please check the boxes by those statements with which you agree:

I agree to follow all program guidelines that will be provided to me and understand that any violation will result in suspension and/or termination of the volunteer mentor relationship.
I undestand that Communities In Schools of North Texas is not obligated to provide a reason for their decision in accepting or rejecting me as a volunteer.
I agree to attend initial volunteer training session(s) and agree to attend at least one in-service training session per year to increase my effectiveness as a CISNT volunteer.

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 regardning 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 individuals served in the CISNT program.

Completing the signature and date field below serves as your signature and acceptance of this agreement.

Signature of Volunteer Applicant:

Date of Signature:

Thank you for agreeing to volunteer with Communities In Schools of North Texas to help students who are at risk of dropping out of school succeed!

If the information in each section above is accurate and complete, please click submit.

Our mission is to be the proven leader in coordinating and providing community-based solutions that challenge young people to overcome barriers, succeed in school and prepare for life.