Moraine Valley Literacy Program Application
 

Mr. Mrs. Ms.      Date: Address: City:    State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     Zip:      Home phone:       Work phone:     E-mail: Date of birth:    Sex:   Male   Female Ethnic group:  Asian  American Indian/Alaska Native  African-American  Hispanic or Latino  White  Native Hawaiian/Pacific Islander Choose not to respond Place of employment: Area or field of work experience (include volunteer experience): How did you hear about the program? Preferred activity (please check all that may apply): Tutor: ABE/GED   ESL  Literacy  Math Computer Lab Aide Special skills or interests: Do you have any teaching experience? (Include volunteer experience—church or on-the-job, etc.) Have you studied a foreign language? (Which) Are you fluent in a foreign language? (Which)     Check the highest level of education completed: High School  GED College Level: 1  2  3  4 Graduate Studies: Years   Major area of study: Other Schooling: Please comment on your reasons for entering the program, reactions to the problems of adult illiteracy, and any personal qualities you feel might contribute to your success as a volunteer in the program.