TUTOR REGISTRATION

Thank you so much for your interest in becoming a Tutor with LVCC. Please read carefully these instructions before completing your online registration.

Fill out every field in the registration form. You will get an error message if fields are not completed.
Click SEND once your form is completed
THEN, scroll down, fill in your credit card information to process your payment, and click SUBMIT

Please note that you need to submit registration form FIRST, and THEN submit payment form.

All tutors and volunteers must undergo a criminal background check. If you are unwilling to undergo such a check, please do not submit an application.

WHICH TUTOR

Adult Tutor

Children and Parents Reading Together Tutor

Both

FIRST NAME*

MIDDLE INITIAL

LAST NAME*

GENDER

Male

Female

ADDRESS

CITY

STATE

ZIP CODE

HOME PHONE

CELL

EMERGENCY CONTACT

EMERGENCY PHONE

EMAIL*

PLACE OF BIRTH

DATE OF BIRTH

RESIDENT

Full-Time

Part-Time

Specify Education Field and Degree*

ADDITIONAL LANGUAGES *

CURRENT EMPLOYMENT STATUS*

Full Time

Part Time

Retired

OCCUPATION (Current / Former) *

HAVE YOU EVER BEEN CONVICTED*

Yes

Tutoring Days

List your preference for tutoring

Day(s)

Time

Any groups/clubs you belong to? e.g. book clubs, tennis group

Please give any additional information about yourself which may be pertinent to this role, including prior experience.

CHARACTER REFERENCES

Please provide LVCC with three character references. We will contact your references prior to matching you with a student.

FIRST REFERENCE

1st Reference NAME:

1st Reference ADDRESS:

1st Reference PHONE:

1st Reference E-MAIL (optional):

SECOND REFERENCE

2nd Reference NAME:

2nd Reference ADDRESS:

2nd Reference PHONE:

2nd Reference E-MAIL (optional):

CONFIDENTIALITY

Never give out personal information about a tutor, student, or volunteer.

Refer any request of information relating to LVCC tutors, students, or volunteers to the appropriate staff.

Personal information about a tutor, student, or volunteer should only be shared on a need to know basis.

As a tutor/student/volunteer for LVCC, I understand in the course of my service, I may learn information about students, tutors, volunteers, or staff which is confidential: e.g. finances, living arrangements. I understand all such information shall be treated as completely confidential even after I terminate my services with LVCC. I agree not to disclose any information of a personal and /or confidential nature to any person not authorized by LVCC to have such information, without specific consent of the individual to whom such information pertains. Failure to comply with this Confidentiality Agreement will result in release from affiliation with LVCC.

INITIALS

TUTOR STATEMENT OF INTENT

As a LVCC tutor, I agree to do my best to carry out the following tutor responsibilities:

Begin or schedule tutoring within a month after completion of training;

Donate a minimum of a year to tutoring;

Maintain confidentiality;

Respect students’ rights and understand their responsibilities;

Promptly complete and return quarterly tutor hours and student progress reports;
When possible, attend in-service training workshops and roundtables, and if for some reason I am not going to be able to carry out my responsibilities as a LVCC tutor, I will let the LVCC Office know and I will return the materials that were distributed to me, so that other tutors can benefit from them. I have read and understand the responsibilities expected of me as a representative of LVCC.

INITIALS

PERSONAL RELEASE AGREEMENT

For good and valuable consideration, receipt of which is hereby acknowledge, I irrevocably grant to Literacy Volunteers of Collier County and it assigns, licensees and successors, the right to use my image and name in all forms and all media including composite or modified representation of all purposes, including advertising, trade or any commercial purposes throughout the world and in perpetuity. I waive the right to inspect or approve any versions of my image used for publication or the written copy that may be used in connection with said images. I release Literacy Volunteers of Collier County and its assigns, licensees and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, and/or rights of publicity or copyright. Literacy Volunteers of Collier County is not obligated to utilize any of the rights granted in this Agreement. I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

INITIALS

RELEASE OF LIABILITY

FOR GOOD AND VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, the undersigned does hereby release LVCC, its licensees, successors, or assigns for any breach of said organization’s written or unwritten policies regarding performance of the undersigned’s duties as a literacy volunteer/tutor, or actions or activities made or performed by the undersigned while performing those duties as a literacy volunteer/tutor or ancillary thereto. It is the stated intention of the undersigned to fully RELEASE the Literacy Volunteers of Collier County to the fullest extent possible, from any and all liability which could arise as a result of the undersigned’s association with said organization, including but not limited to any legal actions, either criminal or civil, and agrees to indemnify and hold harmless the LVCC from any such liability. I have read and understand the terms of this Release and I am of the age of majority and am of sound mind.

INITIALS

FIRST & LAST NAME *

DATE*

SIGNATURE*

Your information will never be shared with any third party.

DON'T LEAVE YET! PLEASE COMPLETE YOUR PAYMENT BELOW TO FINISH YOUR REGISTRATION PROCESS, OR CALL THE OFFICE FOR ASSISTANCE.

This field should be left blank

TUTOR REGISTRATION

Thank you so much for your interest in becoming a Tutor with LVCC. Please read carefully these instructions before completing your online registration.

Fill out every field in the registration form. You will get an error message if fields are not completed.

Click SEND once your form is completed

THEN, scroll down, fill in your credit card information to process your payment, and click SUBMIT

Please note that you need to submit registration form FIRST, and THEN submit payment form.

Tutoring Days

CHARACTER REFERENCES

FIRST REFERENCE

SECOND REFERENCE

CONFIDENTIALITY

TUTOR STATEMENT OF INTENT

PERSONAL RELEASE AGREEMENT

RELEASE OF LIABILITY

DON'T LEAVE YET! PLEASE COMPLETE YOUR PAYMENT BELOW TO FINISH YOUR REGISTRATION PROCESS, OR CALL THE OFFICE FOR ASSISTANCE.