Weed & Seed: Weed and Seed Volunteer Application

-- Back to the "Weed & Seed" navigational category --

WEED AND SEED SAFE HAVEN

APPLICATION (PICTURE ID REQUIRED)

Name:__________________________SS#__________________________

Address:____________________________________________________

Home Telephone:___________________Work Phone:_______________

College/School:______________________________________________

Date to Complete/completed:________________Status:___________

Retired ( ) Teacher ( ) School:________________________

Services:

( ) Tutoring

( ) Mentoring

( ) Counseling

( ) Homework Help

( ) Monitoring

( ) Assisting Staff

( ) Drama/Theater

( ) General Duties

Hours available for services:(a.m.)_________(p.m.)__________

Beginning on:_____________________Ending:___________________

I_______________________agree to provide the duties checked above or other services needed to assist students/adults at the Weed and Seed Safe Haven.

Signature_________________________________Date:______________

For office use only: College ( ) Teacher ( ) Student ( ) Other ( )

Start Date:_________________Staff Signature:_________________

-- Back to the "Weed & Seed" navigational category --