2022-2023 Teton Literacy Center Volunteer Application

2022-2023 Teton Literacy Center Volunteer Application
2022-23 School Year Update

We are currently planning to run our typical programs physically at Teton Literacy Center or an offsite location. Teton Literacy Center Leadership Team will continue to closely monitor CDC protocols with the utmost concern for the safety of our volunteers, students, and staff.
- Masks are welcome, but not required. If you would feel more comfortable wearing a mask, we will continue to have masks available at TLC. If you would like your student to wear a mask we are happy to help facilitate that, please let us know!
- Due to unknown academic impact as well as staff constraints, it is unlikely that TLC will be offering virtual tutoring this academic year.
- Also note, that it is mandatory that all in-person volunteers are vaccinated against COVID-19.
Though we do plan to run our programs physically this academic year, please note that it is subject to change. Following are a few of the many factors that could impact our programs:
- State and/or local COVID-19 guidelines and ordinances. Teton County School District – we will strive to follow the decisions of TCSD. If at any point TCSD determines they will continue with their Virtual Learning Plan, TLC will likely resume virtual tutoring via zoom.
- A TLC student, staff member, or volunteer testing positive for COVID-19.
  TLC staff illness may result in short or long-term cancellation of specific TLC programs that staff member is associated with.
If you have any questions, comments, or concerns, please contact us.

Phone: 307-733-9242

Email: anna@tetonliteracy.org

Thank you!

2022-2023 Teton Literacy Center Volunteer Application
Name*

First NameLast Name
Are you a new or returning volunteer?*

I am a new volunteerI am a returning volunteer

Personal Information
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education Level*
Current Employer*
Gender*

MaleFemaleTransgenderNon-binary/non-conformingPrefer not to respond
First Language*
Other Languages

Emergency Contact Information
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Email*
example@example.com

Diversity, Equity and Inclusion at Teton Literacy Center

Teton Literacy Center is committed to a diverse, equitable and inclusive environment for all of its constituencies that it serves. We seek to live and promote these values where a sense of belonging is being prioritized each and every day.
After examining the images below, what is the difference between equality and equity? Why do you think it is important at TLC? *

COVID-19 Vaccination Status

For the safety of staff, students and families all volunteers who will be physically volunteering are required to be vaccinated against COVID-19. For those who are unvaccinated, virtual opportunities are available and we would love your support this year!
Are you fully vaccinated against COVID-19?*

YesNoOther
Are you comfortable coming into TLC if students and staff are not wearing masks?
What other pieces would you like to see in place at TLC to continue to keep our volunteers and students safe?
Additional Comments:

Returning Volunteers
Have you attended a New Volunteer Training before?*

YesNo
If yes, what month and year was your last training?

References

Please list three local, non-family members. For example, an employer, supervisor, teacher, or coach. Two positive reference responses are required prior to volunteering at Teton Literacy Center.
Reference 1*

First NameLast Name
Reference 1 Email*
example@example.com
Reference 1 Phone Number*
Please enter a valid phone number.
Reference 2*

First NameLast Name
Reference 2 Email*
example@example.com
Reference 2 Phone Number*
Please enter a valid phone number.
Reference 3*

First NameLast Name
Reference 3 Email*
example@example.com
Reference 3 Phone Number*
Please enter a valid phone number.

Release From Liability

I am aware that as a volunteer I expose myself to potential hazards which include but are not limited to: accidents, illness, property damage, etc. I am voluntarily participating in this service with the knowledge of the potential hazards involved and hereby agree to accept any and all risks of injury.I agree that my assignees, heirs, distributes, guardians and other legal representatives will not make a claim against, or sue for injury or damage resulting from the negligence or other acts , howsoever caused, by any employee, agent, or volunteer contractor of the organization as a result of my participation as a volunteer. I hereby release Teton Literacy Center and its officers, volunteers and agents from all actions, claims, or demands that I, my assignees, heirs, guardians and legal representatives now have or may hereafter have for injury resulting from my participation as a volunteer.I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and I sign it of my own free will.
Signature*

Clear
Applicants under the age of 18 need parent/guardian agreement to our liability release. By signing below you agree to adhere to the above Release from Liability for your child.

Clear
Zoom Consent

If I am paired to volunteer virtually with a tutoring student, small group or TLC class, I understand that TLC will supervise Zoom sessions and regularly check-in on me and my student(s), but will not always be present in breakout rooms during the session. Further, I grant permission for my Zoom sessions to be recorded for TLC legal, safety and training purposes. Finally, I understand that TLC will closely monitor all participants to ensure appropriate behaviors, but is not responsible for the words, actions and virtual backgrounds of students and their families.
Signature*

Clear
Applicants under the age of 18 need parent/guardian agreement to our Zoom Consent. By signing below you agree to adhere to the above Zoom Consent for your child.

Clear
Photography Consent
Please initial if we can use your photo in our marketing materials.

Clear
Applicants under the age of 18 require parent initials to consent to use of their photographs.

Clear

Application Submission
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.*

Clear
Applicants under the age of 18 need parent/guardian permission to volunteer. By signing below you authorize your child to volunteer at Teton Literacy Center.

Clear
Should be Empty:

	Monday	Tuesday	Wednesday	Thursday
3 - 4 PM
5 - 6 PM
5:30 - 6:30 PM

2022-2023 Teton Literacy Center Volunteer Application

2022-2023 Teton Literacy Center Volunteer Application

Personal Information

Emergency Contact Information

New Volunteers

General Questions

Logistics and Program Interests

Availability for the 2022-23 School Year

Diversity, Equity and Inclusion at Teton Literacy Center

COVID-19 Vaccination Status

Returning Volunteers

References

Release From Liability

Zoom Consent

Photography Consent

Application Submission