Students from some of Indianapolis’ toughest neighborhoods will soon have access to a free Tutoring Program provided by the GEO Foundation in support of the recent passage of the Edward M. Kennedy Serve America Act, which goes into effect Oct. 1, 2009. For more details, click here.

Thank you for your interest in applying to become a volunteer to tutor with GEO Foundation. Throughout this application, fields marked with an asterisk (*) are required. After submitting this application, a GEO staff member will contact you within two business days.

VOLUNTEER INFORMATION
*First Name:
*Middle Initial:
*Last Name:
*Address:
*City
State:	IN
*Zip Code:
Home Phone:	(at least one phone number is required)
Work Phone:
Cell Phone:
*E-mail:
Employer or School:
Occupation:
*Birth Date:	-- January February March April May June July August September October November December -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991
*School You Want to Tutor in:	-- Fall Creek Academy Fountain Square Academy
First Choice of Interview:	-- Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Sunday AM Sunday PM
Second Choice of Interview:	-- Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Sunday AM Sunday PM
REQUIREMENTS
Please confirm that the following statements in this section are true. All boxes in this section must be checked to continue.
I am at least 18 years of age. I am able to meet with a child on average 2-4 times a month (minimum of 4 hours/month) for one year. I have a valid Indiana driver’s license or state ID and valid auto insurance. (Exceptions are made for students and military personnel.) I have reliable transportation with no recent history of driving under the influence of alcohol or drugs, reckless driving or license suspension for at least 3 years. I have been free of alcohol and drug abuse/dependency for at least 3 years, and I have not used illegal drugs or controlled substances in the past 3 years. I do not have a felony record or criminal record (i.e. misdemeanor) involving a violent crime. I do not have a criminal record (i.e. misdemeanor or felony) within the past 3 years I am willing to disclose medical and mental health history that would affect my ability to mentor a child. I will attend an in person interview with the GEO Foundation. I will give consent for GEO Foundation to complete a background, sex offender and driving record check at my interview. I will submit 3 personal references. If accepted into the program I will attend the required training session and will complete ongoing contacts with Foundation staff. I am aware that if I am not accepted into the program, the reason of non- acceptance will not be disclosed.
REFERENCES
It is your responsibility to designate three (3) personal references, who will be called by a GEO Foundation staff memeber. Your three (3) personal references must include the following: All must have known you for at least 1 year. At least one of them must have knowledge of your home environment. Only one of them can be a family member, spouse or domestic partner.
*Reference 1 Name:
*Reference 1 Phone:
*Reference 2 Name:
*Reference 2 Phone:
*Reference 3 Name:
*Reference 3 Phone:
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