Thank you for your desire to invest in Latino youth!

The questions below will help us to get to know you and match you with a student.

Contact Information

First name:

Last name:

Preferred Name:

Street 1:

Street 2:

City:

State:

* Zip: *

Cell phone:

Other phone:

Email address:

Emergency Contact

In the event of an emergency, whom should we notify?

First name:

Last name:

Cell phone:

Relationship:

Demographics

Please help us get a better idea of the make-up of our volunteers by completing this demographic section. If you are not currently employed, please write "not working."

Date of birth:

Race or Ethnicity:

Gender or Gender Identity:

Employer:

Education

Are you a student?:

Highest Education Level:

If Current Student, School Name:

What is/was your major/degree?:

Languages

What YA! Program site do you prefer?

Please let us know if you would prefer to be a Coach for YA! Minneapolis or YA! St. Paul. We will do our best to place you at your preferred site.

* YA! Site Preference:

YA! Minneapolis

YA! St. Paul

Tell us about yourself

Why do you want to become a Coach?

Experience

Please tell us about your qualities, skills, training, experience, or other attributes that may benefit a youth.

Health History

Do you have any health-related concerns which could affect your ability to perform the activities expected of you as a Coach, or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.

Background Information

Have you ever been...

Denied participation in a youth program:

Investigated for neglect or abuse:

Arrested or convicted of a crime:

If you answered 'yes' to either question above, please explain.

Personal Reference

Please provide us with a personal reference that is not a family member, and can speak to your character.

First name:

Last name:

Cell phone:

Email address:

Relationship:

I Agree

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I agree/understand that: (1) this information may be shared among CLUES staff in order to accommodate my volunteer service with the organization; (2) submitting this application form does not automatically register me as a CLUES volunteer; (3) some volunteer/intern positions may have background check requirements; (4) and there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures, before I may begin volunteering.

My consent begins on the date I sign this form and lasts for the duration of the time I am volunteering at CLUES.

I Agree