Volunteer Application Form

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1 817A Fort Street, Victoria, BC, V8W 1H6, Volunteer Application Form You must complete this application for all volunteer positions with Literacy Victoria. It will take you approximately 15 minutes to complete. If you have not yet viewed our Online Information Session, please do so. Questions followed by * are mandatory fields. First Name: * Last Name: * Street Address: * City: * Province: * Postal Code: * Day phone: *

2 Evening/Cell phone: * * How do you wish to be contacted? * Phone Mail Others (specify): Birth Date (optional): Emergency Contact name: * Emergency contact phone: * Have you volunteered for Literacy Victoria before? * If yes, approximate dates: How did you hear about Literacy Victoria?: Friend Volunteer Victoria Advertisement Lv Website Other Please select your last completed level of education: * High School University Post Secondary Post Graduate

3 Field(s) of Study: * Certifications: * (Please tell us about any certifications, training or special skills you have: e.g. computer courses, trades, WHMIS, Food Safe, first aid, volunteer management, etc.) Employment Experience: * (Please share your previous and/ or current employment experiences including the agency, your roles and responsibilities and length of service. Feel free to add at attached resume if helpful) Volunteer Experience: * (Please share your previous and/ or current volunteer experiences including the agency, your roles and responsibilities and length of service. Feel free to add at attached resume if helpful) Why are you interested in volunteering with LV?: *

4 What do you think are some of the challenges facing adult learners?: * What are your goals and expectations as a LV tutor/literacy helper?: * Please identify the experience(s) you are most interested in: * Learner s Network Tutor Outreach Program Literacy helper Computer Assistant/Tutor Member of the Board of Director Creative Writing Class What areas are you most interested in tutoring?: * Reading, writing Document use Math and numeracy skills Computers and technology Oral communication Interpersonal communication Thinking and problem solving Are there any issues that may impact your ability to act as a tutor/literacy helper? *

5 List We share information with our tutors through our website and s. If you are accepted as a tutor, do you give permission to Literacy Victoria to include your on the tutor list to receive information and announcements from Literacy Victoria? Would you like to be included in our lists? By submitting this Volunteer application, I assert that the information provided in this application is accurate to the best of my knowledge and I authorize Literacy Victoria to verify my qualifications and to contact the individuals whose names I put forward as my references. I understand that this application does not guarantee acceptance as a volunteer tutor at Literacy Victoria and that Literacy Victoria is under no obligation to accept me as a volunteer, or to provide an explanation of the decision made. This application and subsequent information in my file is the property of Literacy Victoria. I understand Literacy Victoria is committed to protecting the privacy of personal information in our possession or under our control in accordance with the Personal Information Protection Act (PIPA). PIPA regulates the way we collect, use, keep, secure and disclose personal information. The personal information collected on this form will be used by program coordinators to identify an appropriate volunteer placement. This information will be stored in a cabinet in a locked office and entered into our secure electronic database to track your volunteer activities. Literacy Victoria values the trust of our donors, volunteers, client, participants and staff. We recognize that maintaining trust requires accountability and transparency in handling personal information. Literacy Victoria welcomes diversity and does not discriminate based on race, religion, culture, gender or sexual orientation. Signature and Date: Questions? Contact us at or

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