UREADING 2013 Application
Last Name: _____________________
First Name: ____________________________
Primary Phone __________________
Alternate Phone: ________________________
Email address: ________________________________________________________________
Gender: Male / Female
Student ID#: _______________ Graduation Year: ____________
REFERENCESPlease provide two references we may call to inquire about your previous employment, volunteer efforts or
academic advancement.
Name
Phone Number
Relation
AVAILABILITYPlease select the day and time slots you are available to work with UReading. Indicate ALL possible times so that
we may better accommodate your schedule. Please note that these are NOT final times for next year’s program.
TUESDAYS / THURSDAYS 8:00AM-10:00AM
TUESDAYS / THURSDAYS 2:00PM-4:00PM
MONDAYS / WEDNESDAYS 8:00AM-10:00AM
MONDAYS / WEDNESDAYS 2:00PM-4:00PM
I DO NOT KNOW MY AVAILABILITY YET.
TRANSPORTATIONBecause our site is off-campus, transportation may involve carpooling, use of campus vehicles, or personal
vehicles. Please let us know your transportation needs by answering the following question. Answers to this
question do NOT impact your chances of being accepted as a Team Leader.
Do you have access to a personal vehicle?
YES
NO
CRIMINAL BACKGROUNDHave you ever been convicted of a crime?
YES
NO
If so, please describe fully the conviction(s) listing the nature of the offense(s), your age at the time of the
offense and your rehabilitation since the conviction(s). (Record of convictions will not necessarily be a deterrent
to doing volunteer work)
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BRIEF DESCRIPTION-(PLEASE ATTACH ADDITIONAL PAPER IF NECESSARY)
1. What motivates you to participate in a program such as UReading? Please explain the qualities and skills that
you feel would enable you to help students become more successful (include related training and volunteer
experience).
2. As a UReading tutor, you will be working with diverse groups of people, including fellow undergraduates,
families, and teachers at local preschools. Many of these people may come from a different cultural and
educational background than your own. What experiences or skills do you possess that prepare you to work
effectively within diverse settings?
3. UReading is an intensive commitment that requires careful attention to attendance and punctuality. Please
comment on your ability to make, and keep, this commitment in a professional manner.
4. PLEASE ATTACH YOUR RESUME.
5. SUBMIT APPLICATION TO EBONY HARRISON BY E-MAIL AT COMMUNITYGA@UR.ROCHESTER.EDU OR DROP OFF AT WILSON
COMMONS 508
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TERMS OF PARTICIPATIONI agree to commit 8 hours per week to UReading (4 hours of session, 2 hours team planning, 2 hours tutor
development)
I agree to adhere to the Rochester City School District’s rules, regulations, and code of conduct.
I agree to attend all training sessions and group meetings conducted by the Program Coordinator.
I agree to maintain confidentiality with respect to all information I may posses regarding my interactions with
RCSD, its students, families and any knowledge of the contents of confidential records
I understand there may be further applications, personal reference checks, interviews, and/or background
checks, in order to be matched with a student.
I understand that any misrepresentation or omission of facts will be cause for immediate dismissal.
The information contained in this application is complete and true to the best of my knowledge.
Signature: _________________________________
Date: ________________
UReading is coordinated by the Rochester Center for Community Leadership