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Area of Interest: Helping in the Office Mentoring Teaching Fundraising Support Other (please visit)
Do you have a mind/body practice? If so, what are they?   What (if any) contact do you have with teens?   Would you be comfortable with mediating, should the need arise?   How often would you like to volunteer? 1x/ week   Special Events/ Weekend Special Events/ Weekday 1x/month   Which hours are best suited for your schedule?   How did you hear about Lineage?   What inspired you to contact us?   Please voice any questions or concerns that you have about working with this population. (This information will be used to cater our orientations to address specific needs):   Part II: Teacher Information For teaching applicants only....Other please skip to Part III   What is your practice or discipline?   Please list any specific training, if any (including certifications and affiliations):   Do you currently have liability insurance?   How long have you been teaching?   Are you interested in working inside a correctional facility or at a community-based center?   PART III REFERENCES   Please provide a total of 3 references who can speak to your ability (or potential) to work with atrisk youth (a combination of personal and professional references is preferred)   Please attach a resume, if applicable as well as any information or brochure about your work.         Signature: Date:   Full Name (Type or Print Legibly)   Other Names Used: (Maiden, Divorced, Alias, Etc.           Status (check appropriate category):   Intern   Volunteer           Will you consent to a background check?:   Yes   No           Have you been convicted of any crime?   Yes   No           Are there any Criminal Charges currently pending against you?   Yes   No       If yes,  Charge:         Disposition:             City    State   Country      Date