EmailMeForm
Volunteer Application (Solicitud de Voluntariado)
All fields marked by a red * must be completed to submit form. This information is necessary for the vetting process.
Name (El Nombre):
*
First
MI
Last
Current Address (Direccion Actual):
*
Street Address
City
State / Province / Region
Postal / Zip Code
Email 1:
*
Email 2:
Cell # (Número Celular):
*
###
-
###
-
####
Alternate # (Numero de Celular Alternativo):
###
-
###
-
####
Occupation (Ocupación):
*
Interests (Intereses):
District Association (Asociación de Distrito):
*
Family of LRSD student
community volunteer
district employee
University student
member of volunteering organization
Partners in Education employee
Choose option(s) that best describe you and your associations with the district (use Ctrl to choose multiple options).
Volunteering Organization/Group (Organización/Grupo de Voluntariado):
*
Type name of organization, group, or church-
ex. Big Brothers Big Sisters, FUMC, AR Kids Read, Rotary
If there is not an group affiliation put N/A.
Volunteer Preferences (Preferencias de los voluntarios):
*
Mentor (weekly)
Tutor (weekly)
Resource speaker
Clerical/staff assistance
Field Trip Chaperone
Reader
PTA/Special Projects
Choose option(s) that you are most interested in (use Ctrl to choose multiple options).
General location (Ubicación General):
*
I'm flexible (Soy flexible).
Central/ Midtown LR
Downtown/East LR
South/Southwest LR
WLR
Choose option(s) that you are most interested in (use Ctrl to choose multiple options).
Specific School(s) Escuelas Específicas:
*
I'll go where needed (Iré donde sea necesario.).
Bale Elementary
Baseline Elementary
Brady Elementary
Carver Elementary
Chicot Elementary
Chicot ECC
Fair Park ECC
Forest Park Elementary
Fulbright Elementary
Geyer Springs ECC
Gibbs Elementary
Jefferson Elementary
ML King Elementary
Mabelvale Elementary
McDermott Elementary
Otter Creek Elementary
Pulaski Heights Elementary
Roberts Elementary
Rockefeller ECC
Romine ECC
Stephens Elementary
Terry Elementary
Wakefield Elementary
Washington Elementary
Watson Elementary
Western Hills Elementary
Williams Elementary
Forest Heights STEM K8
JA Fair K8 Preparatory
Cloverdale Middle School
Dunbar Middle School
Mabelvale Middle School
Mann Middle School
Pinnacle View Middle School
Pulaski Heights Middle School
LR Central High School
LR Hall STEAM Academy
LR Southwest High School
LR West School of Innovation
Parkview High School
Choose option(s) that you are most interested in (use Ctrl to choose multiple options).
The following information is REQUIRED for individuals intending to volunteer in the Little Rock School District.
(La siguiente información es OBLIGATORIA para las personas que deseen ser voluntarias en el Distrito Escolar de Little Rock.)
DOB (Fecha de Nacimiento):
*
MM
/
DD
/
YYYY
SS# (Seguridad Social):
*
Race (La Raza):
Gender (El Sexo):
Felony Record (Registro de Delitos Graves):
*
Yes
No
If yes, please explain (En caso afirmativo, explíquelo porfavor):
I have lived at my current address for at least 7 years (He vivido en mi dirección actual durante al menos 7 años.).
*
Yes
No
Prior Address 1:
*
Street Address
City
State / Province / Region
Postal / Zip Code
# of years at Prior Address 1:
*
If you have not lived at your current address for the past 7 years, please provide prior addresses (Si no ha vivido en su dirección actual durante los últimos 7 años, proporcione direcciones anteriores.).
Prior Address 2:
Street Address
City
State / Province / Region
Postal / Zip Code
# of years at Prior Address 2:
Child Information (Información del niño):
*
Yes, I have children (Sí, tengo hijos).
No, I have never had any children in my custody (No, nunca he tenido hijos bajo mi custodia).
Please provide information for any children that have been in your custody (Proporcione información sobre cualquier niño que haya estado bajo su custodia.).
Child 1:
Name:
DOB:
Child 2:
Name:
DOB:
Child 3:
Name:
DOB:
Child 4:
Name:
DOB:
By providing this information and signing below, you will be authorizing the LRSD to conduct checks including a criminal background check and a Child Maltreatment Central Registry check to determine your volunteer placement eligibility. I authorize law enforcement and background check agencies to release any information that they may have relative to processing this application. I do hereby release the LRSD and all other parties involved in processing my application- from all liability for furnishing such information. I certify all information I provide is true and correct.
(Al proporcionar esta información y firmar a continuación, autorizará al LRSD a realizar verificaciones, incluida una verificación de antecedentes penales y una verificación del Registro Central de Maltrato Infantil para determinar su elegibilidad para la colocación como voluntario. Autorizo a las agencias de cumplimiento de la ley y de verificación de antecedentes a divulgar cualquier información que puedan tener en relación con el procesamiento de esta solicitud. Por la presente, libero al LRSD y a todas las demás partes involucradas en el procesamiento de mi solicitud, de toda responsabilidad por proporcionar dicha información. Certifico que toda la información que proporciono es verdadera y correcta.)
Signature and Date (Firma y Fecha)
*
Clear
ID for Verification (Identificación Fotográfica)
*
Upload a copy of your ID (Sube una copia de tu identificación). i.e. Drivers license, state identification card, passport -
