POI DOE Intern/Volunteer Application

Intern/Volunteer Application

Pueblo of Isleta Department of Education

PO Box 1270

Isleta, NM 87022

505-869-9790

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Date of Birth:*

Phone*

Name of School:*

Course of Study:

Graduation Year:*

Date you will receive degree if college

Term Available:*

Spring Summer Fall

List Skill Strengths:*

For example, skill strengths or core strengths

I am interested in supporting students in the following:*

Student Mentorship Summer Bridge Program Test Prep FAFSA Support Summer Reading Intervention Summer Math Intervention Tutoring

Other:

Grade Levels I am comfortable working with:*

Pre-k -1st 2nd-5th 6th-8th 9th-12th Adult Education College Level

Highest math level you are comfortable with:

Schedule of Availability*

Schedule of Availability
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
8am-12pm	Schedule of Availability: 8am-12pm (Monday)	8am-12pm (Tuesday)	8am-12pm (Wednesday)	8am-12pm (Thursday)	8am-12pm (Friday)	8am-12pm (Saturday)	8am-12pm (Sunday)
12pm-4pm	12pm-4pm (Monday)	12pm-4pm (Tuesday)	12pm-4pm (Wednesday)	12pm-4pm (Thursday)	12pm-4pm (Friday)	12pm-4pm (Saturday)	12pm-4pm (Sunday)
Evening	Evening (Monday)	Evening (Tuesday)	Evening (Wednesday)	Evening (Thursday)	Evening (Friday)	Evening (Saturday)	Evening (Sunday)

CONFIDENTIALLITY: A volunteer shall keep all information confidential, in whatever form, produced, prepared, observed or received by the volunteer to the extent that such information is confidential by law.

Consents *

I agree to abide by all applicable rules and regulation of the Pueblo of Isleta Department of Education I agree to fulfill the responsibilities to the best of my ability. I understand this agreement may be terminated at any time without prior notice.

Any documentation to include data, photographs or drawings, etc. acquired or by the volunteer during the assignment, shall be the exclusive property of the pueblo of Isleta Department of Education. All such materials shall be remitted to the Pueblo of Isleta Department of Education by the volunteer upon completion, termination, or cancellation of service. A volunteer shall not use, willing allow, or cause to have such materials used for any purpose other than the performance of the volunteers service under this agreement without prior written consent of the pueblo of Isleta Department of Education.*

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Date*