First Name (legal)
Last Name (legal)
Are you over the age of 21?* Yes No
Contact Information:
*Please note that e-mail is D2DL’s primary means of contacting volunteers about possible opportunities. We may also send occasional announcements with agency news/updates.
Please note any restrictions on your contact info (e.g. please do not leave messages on my daytime phone)
Employment:
Employment Status: Not employed Full Time Part Time Retired
If employed or retired, who is/was your last employer?
What is/was your position title/description?
Education:
Are you currently in school? No Full Time Part Time
If yes, which degree are you currently pursing?— GED/ HS Diploma Associates or 2 year degree Bachelor’s Masters Doctorate
If yes, What is your field of study?
What is the highest level of education you have completed?GED/ HS Diploma Associates or 2 year degree Bachelor’s Masters Doctorate
Do you have any special certifications/licenses?
Volunteer Experience:
Have you ever volunteered for another youth agency?No Yes
Where?
Briefly describe any previous volunteer experience you may have:
Have you ever had your volunteer or professional involvement at any organization terminated for cause? yes no
If Yes Explain:
Do you consent to have your name / photo published as an D2DL volunteer? (Check all that apply)Name Photo No, my name or photo may not be published
Volunteer Availability
What type of time commitments are you seeking to make or are willing to offer as a volunteer? (Check all that apply)Weekly Monthly Special Events Short Term Long Term Summer Occasional Unsure Flexible Other:
Please describe your availability: (We will always give as much advanced notice as possible.)
Are you available to assist with special events on weekends? Yes No
Further Information:
Other than English, what languages do you speak – including American Sign Language (ASL):Fluent Conversational Translator Teacher Fluent Conversational Translator Teacher Fluent Conversational Translator Teacher
Background Check Information:
As a youth serving agency, we are dedicated to providing a safe space for our young people. As a means of ensuring this environment, all volunteers are required to undergo a state and federal background check through the New York City Department of Education. This background check will disclose any convictions on your personal record; and D2DL will be informed of any arrests during your period of volunteer service. In advance of your completion of the fingerprinting process, please disclose any convictions for felonies, misdemeanors, or violations on your personal record below. Convictions do not necessarily mean that you are ineligible to volunteer at D2DL, and will be considered on a case-by-case basis, dependent on the nature of the conviction(s). Failure to report convictions can lead to your immediate dismissal from the Volunteer Program.
Do you consent to a background check (fingerprinting)? Yes No
Have you been previously fingerprinted by the NYS Department of Education: Yes No
Have you ever been convicted of a crime, other than a minor traffic offense? No Yes
Would you like to make a donation to the D2DL to help offset fingerprinting costs? Yes No
How did you hear about D2DL / How were you referred to the Volunteer Program?
Is there any other information that you would like us to know?
References:
Please provide the names of three references whom we may contact, including one reference from a current or recent employer when possible:
Please check “I Agree” below to indicate that you have read and understand the following terms:
I certify that all if the information given by me on this form is correct, true and complete. I understand that the falsification or omission of any information on this application may be considered sufficient cause for immediate dismissal from the Volunteer Program. I understand that if I am offered a volunteer position with D2DL, the offer is contingent on satisfaction of certain pre-conditions, including but not limited to, NYC Department of Education (DOE) fingerprinting and security clearance, prior employment verification and reference/background checks, and the completion of a volunteer orientation. Should these or any other pre-conditions not be met then I understand that the offer of a volunteer position may be immediately revoked by D2DL. Further, I hereby understand and acknowledge that should I be offered and accept a volunteer position with the D2DL, my volunteer position would be of an “at will” nature, which means that I may leave my position at any time and D2DL may discharge me at any time with or without cause.I Agree With Dare 2 Dream Leaders Terms & Condition
The Dare 2 Dream Leaders (D2DL) makes volunteer recruitment and placement decisions without regard to sex, race, color, religion, national origin, citizenship status, marital or partnership status, sexual orientation, age, disability, HIV status, gender identity, gender expression or any other category protected by local, state or federal law.