Volunteer Registration Form

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Tutoring Interest area(s)*

Briefly describe your background of experience: (Education & Work)*

Describe your interest in working with an undereducated minority population:*

Terms & Conditions:
• I understand that this is a Drug and Alcohol-Free learning environment.
• I understand that all students must be treated with respect in relation to Race, Sex, and /or Religion.
• I understand that I will need to call Janis Hedberg or Becky Viersen 24 hours in advance if I can not meet with my student(s) at my assigned time.
• I understand that Janis Hedberg or Becky Vierson is available to discuss problems that may arise in the tutoring situation. All information regarding the student’s needs must remain confidential.

I agree the terms as listed above*

I agree

Bridge the Gap Mission
153 Jamison Woods Lane Apex, NC 27539
919-851-4535

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Bridge the Gap Mission
153 Jamison Woods Lane Apex, NC 27539
919-851-4535

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