El Espejo Application

~El Espejo~
IMPORTANT MEMBER INFORMATION

Live Scan Fingerprints:
Lennox School District Policy states that all school staff, faculty, and volunteers must have fingerprint records with the school at which they work.  This includes all El Espejo mentors.  No one will be able to mentor without these fingerprint records.  If you work for the Lennox School District and have had this done, or if you did this with us last year, you don't have to be fingerprinted again.  Ask us for a form and location where you can be fingerprinted.

~Members will be remibursed for fingerprints by submitting a receipt and copy of fingerprint form to Lennox Middle School~

TB Shot:
Lennox School District policy also states that everyone working or volunteering at a Lennox School must have had a TB shot within the last three years.  Upon submission of this applifcation, please providue us with proof (i.e. a copy of your vaccination records) that you have had a TB shot within the last 3 years.

Mandatory Workshop:
In order to volunteer as a mentor, you must attend a mandatory workshop.  Workshop times will be announced at a later date.

~In addition to the satisfaction you will recieve by helping these students, you will also recieve community service hours throught the Center for Service and Action.  These recorded hours will demonstrate that you have volunteered your time to help make this world a better place.  In order to have your hours recoreded, you will have to fill out a CSA contract that will be provided by your Head Mentor~

Thank You!

The El Espejo E-board

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Personal Information: Full Name: Email:  Enter a valid email address. Example: name@company.com Local Address: Local Phone:  Enter a valid phone number. Example: 123-456-7890 Preferred Contact Time: Permanent Address: Permanent Phone:  Enter a valid phone number. Example: 123-456-7890 Gender: Male Female Year in School: 1st 2nd 3rd 4th 5th or more Major: Are you interested in being an E-board Member Yes No MENTORING INFORMATION: Are you Bilingual in Spanish: Yes No What day would you like to mentor: Tuesday (3:00-4:30) Wednesday (3:00-4:30) Thursday (3:00-4:30) Friday (3:00-4:30) CARPOOL INFORMATION: I can provide carpool for students: Yes No Time 2:30pm 3:00pm Location: Alumni Mall Flag Poles UHALL Flag Poles I need a carpool: Yes No Time: 2:30pm 3:00pm Location: Alumni Mall Flag Poles UHALL Flag Poles MEDICAL HISTORY: Please list any health conditions (i.e. physical handicaps, disabilities):