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Service Learning Application
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Service Learning Application
Service Learning Application
Full Legal Name
*
for purpose of background check: please include First, Middle, and Last name(s)
Preferred Name
Other Names Used
Including unmarried name if applicable
What School Do You Attend?
*
Kalamazoo College
Western Michigan University
Loy Norrix
Kalamazoo Central
Other
Date of Birth
*
00/00/0000
Email Address
*
Address
City
State
Zip Code
How long have you lived at this address?
*
this information is required for the background check process
Phone
*
(000) 000-0000
Emergency Contact First Name
*
Emergency Contact Last Name
*
Emergency Contact Phone Number
*
(000) 000-0000
Experience
Current Place of Employment
*
Education
*
High school diploma/GED
Some College
Associate's Degree
Bachelor's Degree
Some graduate work
Master's Degree
PhD/MD/JD
Languages spoken (other than English)
Gender
*
Female
Male
(needed for the purpose of background checks)
Personal Pronouns
she/her/hers
he/him/his
they/them/theirs
other
(check any that apply to your identity)
Do you volunteer with other organizations?
*
Yes
No
If so, where?
Finding your place with us
In fewer than 250 words, tell us about your applicable experience with young learners. If you have none, tell us about any experience you've had that will be valuable to our students.
*
Employing your creative voice, tell us who you are in a way that no one else could. (100 words max, please.)
*
Why did you select RAWK to fulfill your Service Learning Requirement? Aside from credit for your class, what do you hope to gain from engaging with RAWK and our students?
*
In the interest of protecting the safety and well-being of our students, we need to ask:
Have you ever been convicted of or plead guilty to a crime?
*
No
Yes
The Fine Print
Media Release
Yes
No
I permit Read and Write Kalamazoo to take photographs, audio, and video recording of myself for the explicit purpose of chronicling, promoting, and celebrating the RAWK program. I understand that any media taken of myself taken during RAWK programming will not be used by anyone not affiliated with Read and Write Kalamazoo.
A lot of words of great importance:
As a condition of volunteering, I give permission for Read and Write Kalamazoo (RAWK) to conduct a background check on me, which may include a review of sex offender registries, child abuse, and criminal activity records. I understand that, if appointed, my position is conditional upon the staff at RAWK receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability RAWK, the employees and volunteers thereof, or any person or organization that may provide such information. I hereby grant to RAWK, and its authorized agents, vendors, officers, directors, employees, licensees, affiliates, successors, and assigns the non-exclusive, irrevocable, perpetual, world-wide right and license to use, reproduce, display, perform, edit, create derivative works of, and distribute, in whole or in part, any photographs and/or recordings taken by or of me during activities sponsored by RAWK, for any purpose, in any and all manner or media now known or hereinafter developed. By signing below, I acknowledge that I also understand that RAWK appreciates me and my enthusiasm, but I also acknowledge that RAWK is not obligated to appoint me to a volunteer position.
Please enter your initials to indicate you agree to the above terms.
*
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