At what times are you interested in tutoring?

Monday day __ eve __
Tuesday day __ eve __
Wednesday day __ eve __
Thursday day __ eve __
Friday day __ eve __
Saturday day _ eve __
Sunday day __ eve __

Other: Background Check

Due to the nature of this one-on-one volunteer position, the Literacy Outreach Centre requests that you agree to having the following background checks conducted.

Police Records check:    Yes    No

In addition, we request that you provide two references that we may contact:

(Personal) Name: ________________________ Phone: _________________

(Employment) Name: _____________________ Phone: _________________

The Literacy Outreach Centre will only use the above information in determining your suitability for particular volunteer positions and all such information shall be kept confidential.