Date Received:________________ Center:___________

Regular Volunteer Day (s):________________________

Students(s)/Group(s) Assigned:_____________________

(for staff use only)

THE PATRICIA M. SITAR CENTER FOR THE ARTS APPLICATION FOR SUPERVISED VOLUNTEER WORK WITH CHILDREN

(Information obtained will be kept confidential by the Sitar Center)

Name:______________________________________________ Date:____________________________

Current Address:_______________________________________________________________________

City:____________________________ State:__________________ Zip:_________________

Home Phone:_____________________ Date of Birth:______________________________________

Current Employer:________________________ Position:___________________________________

Work Address:_________________________________________________________________________

Work Phone:_____________________________ Dates of Employment_________________________

Fax:____________________________________ Email:_____________________________________

Educational Background (Please include school, location, diploma/degree, year):

As specifically as you can now determine, what are you volunteering to do and what time commitment you are planning to make? (e.g. “computer lab supervision 2 hours a month through December” of “tutoring 6 to 7 p.m. every Tuesday for the ‘2000-2001 school year.”)

Please list any other ways that you or your employer could support the Sitar Center (e.g. “recruiting volunteers, fundraising, PR, in-kind goods or services, contacts, talents to share, activities to lead): __________________________________________________________________________________________________________________________________________________________________________________________

How did you first learn of the Sitar Center? __________________________________________________________________________________________________________________________________________________________________________________________

The Patricia M. Sitar Center for the Arts * 2525 Ontario Rd., NW * Washington, DC 20009 * 202-797-2145

Date that you are available to start volunteering at the Sitar Center_________________________________

Please list your employment history for the last two years if other than your current employer. Include employer’s business name, address and telephone number, your position and dates employed:

Have you had previous volunteer or youth work experience? Yes______ No______

If yes, please provide the name and phone number of your supervisor or person able to comment on your work:

References: Please print the name, address and phone numbers (work and home) of three people, other than relatives, who have known you for at least three years.

1.____________________________________________________________________________________________

2.____________________________________________________________________________________________

3.____________________________________________________________________________________________

I give permission for The Sitar Center and its authorized representatives to contact any of the above listed people for reference checks.

Signature of Applicant:_________________________________________ Date:________________________

Volunteer Consent

The Patricia M. Sitar Center for the Arts will take every reasonable precaution to provide for the safety of the volunteers while participating in the Sitar Center activities, which sometimes includes car or van travel. I understand that volunteers may not drive Sitar Center students unless such volunteers have valid insurance policies which contain the legal minimum for bodily injury, property damage and uninsured motorist.

By my signature, I acknowledge that neither The Sitar Center , nor any of its staff, nor participants will be held liable in the event of accident or injury to my person.

Signature of Applicant:_________________________________________ Date:________________________

Limitation of Contact with Students

I understand that the scope of my activities as a Sitar Center volunteer is limited to those activities authorized by The Sitar Center. I further understand that no volunteer may take any students on any outing not authorized by The Sitar Center. Please contact our staff if you have any questions.

Signature of Applicant:_________________________________________ Date:________________________

The Patricia M. Sitar Center for the Arts is a nonprofit, tax-exempt organization under IRS code section 501(c)(3).

The Federal Tax Identification number is 52-2113471.