Tutor Application – SAY Play Center

1 Contact

2 Experience

3 Availability

4 Background

5 Review

All fields marked with * are required to complete each section of the application. You may save and return to the application at any time.
Contact Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Birthday*
Month
Day
YYYY
Gender*
(needed only for background check)
Ethnicity*
(needed only for background checks)
- Hispanic or Latino
- Not Hispanic or Latino
Race*
(needed only for background check,select all that apply)
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White
Home Phone
Cell Phone*
Work Phone
Email*
Can you be contacted at work/during work hours?*
- Yes
- No
Emergency Contact/ Relationship to You*
Phone*

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Experience
Current Job and/or school*
**If you are currently a student, please include the type of degree you are seeking.
Education/special training*
Volunteering*
Hobbies/special interests*
How did you find out about S.A.Y. Detroit Play Center?*
What are the factors that motivated your interest in joining S.A.Y. Detroit's Volunteer Tutor Program?*
What personal, professional, experiential, or other skills and/or resources would you offer to S.A.Y. Detroit Play Center as a volunteer tutor?*
What do you expect from your volunteer tutor experience?*
Have you been involved with an organization that serves children? If yes, in what capacity?*

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Availability and Preferences
S.A.Y. Detroit Play Center is asking that our volunteer tutors dedicate two hours of their time at least once a week, preferably twice. Students will be tutored twice each week, and we need tutors who can be there at least one of those two days consistently. This will allow you to build meaningful relationships and make true academic gains with your same student or small group of students. We are also asking that your commitment last for at least one semester.
Hours of Availability*
Please indicate which days you are available in order to schedule you on a day that works best for everyone. Shifts are from 4:00 p.m. - 6:00 p.m.
- Monday, 4:00 - 6:00 p.m.
- Tuesday, 4:00 - 6:00 p.m.
- Wednesday, 4:00 - 6:00 p.m.
- Thursday, 4:00 - 6:00 p.m.
Preference*
In order to make the most of your volunteer tutoring experience at S.A.Y. Detroit Play Center we would like to know which age group you prefer to work with:
- Elementary School (Third-Fifth Grade)
- Middle School (Sixth-Eighth Grade)
- No Preference

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Background Information
1. Has disciplinary action (of any sort) ever been taken against you by a licensing board, professional association, or educational/training institution?*
2. Are there any complaints pending against you in any of the above named entities?*
3. Have you ever had a civil suit brought against you relative to your professional work? If so, is the case currently pending?*
4. Do you have a history of addiction of any sort (gambling, substances, etc.)? If so, please list.*
5. Do you have a history of substance abuse with any illegal/recreational drugs, prescription drugs, over-the-counter drugs, or alcohol?*
6. Have you ever been charged or convicted of allegations of domestic violence, abuse, etc.?*
7. Have you ever had a restraining order, injunction, order of protection (or the like) issued against you because of allegations of domestic violence, abuse, etc.?*
8. Have you ever been charged with, arrested, indicted for, pled guilty to, or convicted of a violent or non-violent felony, in the state or federal division, in any other state outside of Michigan?*
9. Have you ever been charged with, arrested, indicted for, pled guilty to, or convicted of sexual misconduct including: abuse of power or role for sexual purposes, sexual contact with a minor or an adult incompetent to give consent, sexual assault (i.e. rape), solicitation for sexual purposes (i.e. commercial sex work), or an offense related to pornography or public indecency (i.e. indecent exposure) in any state outside of Michigan?*
10. Have you ever been charged with, arrested, indicted for, pled guilty to, or convicted of misappropriating funds or otherwise violated trust/confidence agreements in any professional or personal capacity?*
References
Please list two people (not family members) who can provide a character or experience reference on your behalf.
Reference Name*
First Last
Phone
Email
Reference Name
First Last
Phone
Email

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Preview & Confirmation
Review your submission before signing below.
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Compliance*
- I understand that I must attend an orientation and training session before I begin my volunteer service. I also understand that I must comply with all of S.A.Y. Detroit Play Center’s requirements prior to and during my volunteer service.
Background check*
- I understand that S.A.Y. Detroit will conduct a background check and I authorize it to investigate all statements in this application and authorize any person or entity named in the application to fully explain the circumstances of my statements. I understand that misrepresentation or omission of facts called for is cause for removal from the volunteer program.
Signature*
(use your mouse on a desktop/laptop or your finger on a mobile/touchpad to add your signature)
Email
This field is for validation purposes and should be left unchanged.

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Volunteer Application: Reading Coaches & Homework Tutors

Contact Information

Experience

Availability and Preferences

Background Information

References

Preview & Confirmation