Everett Public Schools

Volunteer

Completion of one application

Application

will allow you to volunteer

or work as a community partner in all Everett schools.

School/Office Use Only

Date to Comm.

School/Dept.

Code

Date Approved

Previously screened

r

Have you completed a volunteer application for any Everett school in the past three years?Yes

r

No

r

Legal name

List all previous names

(maiden, previous married names, etc.)

Your date of birth

E-mail

Address

City

State

Zip

Telephone (day/cell)

(evening)

Business/Company

(if applicable)

Title

Emergency contact

(phone)

Please check one:

parent of a student

r

grandparent/relative of a student

r

non-parent/community member

r

If you have a child attending an Everett school please list:

Child(rens) full name(s)

School(s)

Grade

Please list the location(s) where you will be volunteering, either now or in the future:

child’s school (see above)

r

no preference

r

potentially all schools

r

other (listed below)

r

Please check the areas in which you may be volunteering:

Field Trip Chaperone

r

Presentation Panelist

r

Mentor Matters (partnership w/Big Brothers/Big Sisters)

r

Classroom Helper

r

Reading Tutor

r

Math Tutor

r

Culminating Exhibition Mentor

r

Walkabout Program

r

Other (please list):

(OPTIONAL) Please indicate the

days

and

hours

you are available to volunteer:

Monday

r

hours

Wednesday

r

hours

Friday

r

hours

Tuesday

r

hours

Thursday

r

hours

Everett Public Schools, Communications/Volunteers

P.O. Box 2098

•

Everett WA

•

98213-0098

•

(425) 385-4041

I understand that a State Criminal History Background Clearance is required and that my

service as a volunteer and/or community partner depends on approval. I release the Everett

School District from any liability as a result of receiving any information.

Signature

Date

First

Middle Initial

Last

(Please use black ink.)