Today’s Date: _____________________________________
Town: _____________________________ Postal Code: __________________________
Phone: ____________________________ Email: _______________________________
Gender: ___________________________ Birthdate: ____________________________
When are you available to tutor? Please indicate day and time, for example, Monday mornings; Saturday afternoons; anytime
We try to pair you with a student who has similar interests to yours. Your answers to the following questions will help us to do that.
What is/was your occupation? _______________________________________________
What do you enjoy doing? For example: crafts, being outdoors, gaming, working with animals.
What skills are you comfortable teaching? (Circle as many as apply)
Reading Writing Spelling Grammar Pronunciation
Vocabulary Speaking Listening Computer Math
Are you interested in tutoring one-on-one, or are you interested in working with a small group of no more than 4 people? Circle which one (s) apply.
What are you not interested in and/or able to do within this tutoring program? (i.e. you won’t volunteer for us anymore if you have to teach or do…..)
What are you personally seeking to learn or gain from volunteering with this tutoring program? (i.e. if they sky was the limit you would love to be able to do…..)
We provide tutor training prior to pairing you with a student. Do you already have tutor training or tutoring experience? If so, please tell us about it.
What other languages do you speak? _________________________________________
Do you have a valid Criminal Record and Vulnerable Persons check? Yes____ No____
If you answered “No” – PSPL staff will provide you with the forms to have one completed.
Individuals who come to the Parry Sound Public Library (PSPL) for help with their literacy skills do so with an expectation of and a need for privacy. The student should be the primary source of information about themself and only information that is essential to providing service should be requested.
All volunteers and paid staff must respect the need for privacy. Staff and volunteers are not to identify or discuss students with other tutors, family, friends, and acquaintances. They must avoid using details about the student or the student’s life that would reveal the student’s identity. It is important to realize that due to the close nature of our social environment, it is easy to identify people by details of their personal lives. This code survives the period with which an individual volunteers with or works with PSPL.
Staff and volunteers must not provide other service agency personnel, including social workers, probation or employment officers, with details of the student’s progress without the written or verbal permission of the student. All inquiries from agencies or others can be referred to a PSPL staff member.
Staff and volunteers are encouraged to talk about the PSPL Tutoring Program, to be positive literacy role models in the community and to act as ambassadors for the adult literacy program.
This code is meant to guide staff and volunteers in maintaining the privacy and dignity of the students participating in the PSPLs adult literacy program at PSPL.
I, ____________________________________ agree to the Confidentiality Code.
I, ____________________________________ hereby grant permission to Parry Sound Public Library to take and use digital images and/or photographs of myself for use in various printed publications, websites to promote the Libraries programs and services including use on social media and print. I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions shall be the property of Parry Sound Public Library.
I agree that my name may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions shall be the property of Parry Sound Public Library.
Signature ___________________________ Date:__________________________
Periodically, PSPL staff will either email you program information or share your email address, as required, with your student(s) or other tutors. This information will be emailed or shared by PSPL staff using firstname.lastname@example.org.
If I’ve circled YES, I agree, or if I’ve circled NO, I do not agree to receive PSPL program information or for the PSPL staff to distribute my email as required.