Application

Volunteer Application Form

Thank you for your interest in volunteering with Lead to Read KC. Please complete this application and code of conduct to ensure prompt processing and placement. We will forward this information to the appropriate school district.

All volunteers are required to complete a background screening. You will receive more information from us after you submit the form.

* Required Fields

Applicant Information

Full Name

Date of Birth

Address


  

Contact Details

 
 

Emergency Contact

  

Employer Details if applicable


Volunteer Information

School

School District

Volunteer Availability

Volunteer Skills

How did you hear about us?

Volunteer Notes

Shared Volunteer: If you and friend or colleague are sharing a student for the school year please provide their name and contact information below. Both volunteers need to complete this online application and background screening.

  

Criminal History

* Ever been convicted of a crime other than a traffic violation? Yes No
* Any felony or misdemeanor? Yes No
* Any DUI/DWI? Yes No
* Is your driver’s license suspended? Yes No
* Any felony, misdemeanor or municipal charges pending against you? Yes No
* Have there ever been allegations, complaints or reports regarding your involvement in child abuse or neglect? Yes No
If you answered yes, please provide the date, description, and explanation of each incident

References

Please list two references of people who know you well, other than relatives, preferably for whom you have worked in either a paid or volunteer capacity.

First Reference

 
 

Second Reference

 
 

Applicant Authorization and Agreement

You have my permission to contact my employer. I understand that any omissions or misstatements made by me on this application may be cause for my application to be declined or volunteer placement to be terminated. I understand that all information, including driver’s license, criminal background, and child abuse/neglect records and sex offender registry, will be verified and hereby consent to such verification. I declare that all the statements I have made on this application are true, correct, and complete to the best of my knowledge. I understand that the school district, at its sole and complete discretion, may accept or decline this application without providing me any reasons for the decision.

* I have read and agree to Lead to Read Code of Conduct
* Applicant Signature (Checking this checkbox is equivalent to your handwritten signature)