Name: ____________________________________________________ Date: ___________________________

Address: ___________________________________________________________________ X1A ___________

Phone: Home ____________________ Work ____________________

e-mail __________________________________________________________________

Emergency Contact: _____________________________________________ Phone: ____________________

So that we understand your skills and personal interests, please provide the following information:

1. Describe your educational background:

__________________________________________________________________________________________

__________________________________________________________________________________________

2. Previous volunteer experience:

__________________________________________________________________________________________

__________________________________________________________________________________________

3. How did you find out about the tutor training workshop?

__________________________________________________________________________________________

__________________________________________________________________________________________

4. Current occupation:

__________________________________________________________________________________________

5. Why do you want to become a volunteer tutor?

__________________________________________________________________________________________

__________________________________________________________________________________________