May we call you at work?
Male Female Other
Date of Birth
African American Asian Caucasian Hispanic/Latino Native American Other Not Given
Married Single Divorced Widowed Separated Cohabiting
Employment Status (Check One)
Employed Retired Homemaker Other
Employer (previous, if retired)
Last year of school completed?
Jr. High (6th - 8th) High School (9th - 12th) College Grad School
Degrees (please specify)
Other education or training
Please specify your area of interest as a volunteer. (Check as many as apply)
Tutor (Literacy or Drop-in) Classroom Assistant Computer lab Assistant Office Assistant Career Mentor Special Events Publicity/Fundraising Board Member Other
Why are you interested in working as a volunteer for SBLC?
How did you learn about our program?
If interested in working with adult learners, do you have any tutoring/teaching experience? Please describe.
Are you willing to learn to teach?
A Small Group A Student with a learning disability or a slow learner
Please describe any previous volunteer experience
How many hours per week are you available as a volunteer?
2-3 4-5 5-6 7-8 9-10
Do you speak any languages other than English?
Do you have any special skills or training?
List one professional and one other reference (non-relative) of individuals who have known you for ore than one year:
28 E Ostend Street
Baltimore, MD 21230
©2016 South Baltimore Learning Center
SBLC programs are partially supported by grant funding from the Department of Labor, Licensing, and Regulation, the U.S. Department of Housing and Urban Development, and the State of Maryland.