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Chicago Lights Tutoring New Volunteer Application 2022-2023
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* Indicates required question
First Name
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Your answer
Last Name
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Your answer
Address
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Your answer
Apartment Number
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Business or School Name
Your answer
Business or School Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Job Title/Description
*
Your answer
Home Phone (please answer in (xxx) xxx-xxxx format)
Your answer
Cell Phone (please answer in (xxx) xxx-xxxx format)
*
Your answer
Work Phone (please answer in (xxx) xxx-xxxx format)
Your answer
Email Address
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Your answer
I am most easily reached by my: (check all that apply)
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Home#
Cell#
Work#
Email
Required
What is your gender or gender identity?
*
Prefer not to answer
Other
Female
Male
Birth Date (please answer in xx/xx/xxxx format):
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Your answer
Age
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Your answer
What category or categories best describes your race or ethnicity? Please check all that apply:
Black or African American
Latinx, Hispanic, or of Spanish origin
White
Asian
Asian Indian
Middle Eastern or North African
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Prefer not to answer
Other:
Do you have children of your own?
*
Yes
No
If yes, what are their ages?
Your answer
Are you a member of Fourth Presbyterian Church?
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I am a member
Not a member, but I attend
Not a member
How did you hear about Chicago Lights Tutoring?
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Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Number (please answer in (xxx) xxx-xxxx format):
*
Your answer
Are you Vaccinated? (Chicago Lights Tutoring requires all Volunteers to be vaccinated)
*
Yes
No
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