Each One Teach One Application Packet

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Each One Teach One

Application Packet

Thank you for your interest in Each One Teach One! We are passionate about changing the

lives of K-12 students through tutoring and mentoring, and hope you’ll join our effort.

This packet provides an overview of EOTO programs to help you consider where you’re best

suited to tutor, and all of the application materials you’ll need.

Although the packet may

seem large, it is very simple to complete!

Application Checklist

Complete the EOTO Volunteer Application

You must include all information in order to be considered. Be sure to complete both sides of each page.

Read and sign the Volunteer Standards of Conduct

All applicants must complete this form; certain sections do not apply to College Bound volunteers.

Complete the Request for Child Abuse or Neglect / Criminal Record form

Complete the sections marked with arrows. Social security numbers are required for background checks.

Arrange for 2 Volunteer Reference Check forms to be completed

References can come from anyone: friends, RAs, WUSAs, advisors, professors, employers, and mentors. References can be brief, using the space on the form provided.

Submit your two completed reference check forms with your other materials.

Read and sign the Community Service Project Release

Include a brief statement of interest with your application

Mark your calendar for the key dates below

Key Dates

Jump Start KIPP: Victory KIPP: Inspire College Bound Application Deadline Wednesday September 10, 5pm

Community Service Office – DUC 150 by the fireplace

Individual Interviews September 11-12

Sign up for a 15-minute interview when you submit your application

Placement Notification By September 12, 7pm

Training Sunday, September 14, 2014 1-5pm in the DUC

Tutoring Calendar Tutoring calendars for each program are available for download at

www.communityservice.wustl.edu/eoto

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Each One Teach One

Overview of Programs

Jump Start.

EOTO: Jump Start partners with St. Louis Public Schools to provide an after-school tutoring program at Ford Elementary, which primarily serves under-resourced students and are identified as chronically low-performing schools. Based on their academic needs and potential, students in grades 3-5 are identified by the schools to attend the program Monday through Wednesday. Tutors offer individualized attention on reading and writing, using the

Newspaper in Education: STEM (Science, Technology, Engineering and Math) portion of the St. Louis American newspaper as a resource to fine-tune these skills with an interdisciplinary approach.

KIPP Partnership.

The KIPP (Knowledge is Power Program) network is comprised of 125 high-performing public charter schools throughout the United States. KIPP schools are unique because they employ a college-focused culture to change the trajectory of the under-resourced students they serve. Washington University sponsors KIPP in St. Louis, and plays an active role in assuring the success of its students and its growing network of local KIPP schools. EOTO works with the following KIPP Schools in St. Louis:

KIPP Inspire. The mission of KIPP: Inspire Academy is “to inspire all students to develop the character and

academic skills necessary to succeed in high school and college so that they can build a better tomorrow for themselves and us all.” Tutors experience KIPP’s unique college focused environment, and, most importantly, tutor highly motivated KIPP 5th-8th grade students on their path to college.

KIPP Inspire: Science Olympiad. WU students involved in the Science Olympiad program at KIPP:

Inspire Academy work to build strong learning partnerships with 6th-8th graders as they prepare for the annual Science Olympiad tournament. With a focus on engineering, chemistry, and physics, WU students act as coaches, preparing lesson plans each week that help students learn, achieve, and grow in a fun team-based environment. Coaches are expected to make a two-semester commitment.

KIPP Victory.

Students at KIPP: Victory Academy are “grounded in the belief that kids deserve a nurturing, challenging, joyful environment in which to learn, grow and achieve at the highest levels.” Students at KIPP Victory Academy are immersed in a high-energy environment that focuses on preparing students to be exceptional learners and self-advocates. Tutors play a pivotal role by assisting kindergarten and 1st grade students, in small group learning environments, as they develop key foundational skills.

College Bound.

EOTO: College Bound is a partnership with the local non-profit organization, College Bound. College Bound’s mission is to “provide promising high school students from under-resourced backgrounds with the academic enrichment, social support and life skills needed to apply, matriculate and succeed in four-year colleges.” Within the broad range of opportunities provided by the organization, EOTO: College Bound mentors work with high school

students one-on-one, serving as academic tutors, role models, and friends. As an EOTO: College Bound mentor, you can interact with students close in age who are motivated, tenacious, energetic, and often quite independent.

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Each One Teach One

Program Details

Jump Start KIPP: Victory KIPP: Inspire College Bound Community Partner St. Louis Public

Schools Knowledge Is Power Program Knowledge Is Power Program College Bound

Schools Ford Elementary KIPP: Victory

Academy KIPP: Inspire Academy University City HS Clyde C. Miller Career

Academy Roosevelt HS

Maplewood-Richmond Hts HS

Grade Levels 3-5 K-1 5-8 (Study Hall Team) 6-8 (Science Olympiad Team)

10-12

Tutoring days & time

(Transportation time included)

Monday – Wednesday 3:30-5:30pm

(2-3 transition tutors begin at 2:30)

Monday – Thursday

3:15-5:00pm Monday – Thursday 3:30-5:30pm Sunday 2:30-4:30pm (35 tutors)

Wednesday 4:00-6:30 (10 tutors)

Weekly time

commitment 2 hours 2 hours 2 hours Sunday: 2 hours

Wednesday: 2.5 hours

Transportation Bus from campus CarShare /carpool

(funded by CSO) CarShare /carpool (funded by CSO) Sunday: On campus Wednesday: College Bound office (CarShare / carpool funded by CSO)

Total number of

tutors 45 40 60 (Study Hall Team)

60 (Science Olympiad Team)

45

Questions? We’d love to hear from you!

Community Service Office

eoto@wustl.edu or 314.935.5599

communityservice.wustl.edu/eoto

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First Name: _____________________________Last Name: _____________________________ Student ID: ___________________

South 40 residents: 6515 Wydown Blvd, Campus Box ___________, St. Louis, MO 63105; ___________________________________ (Building) (Room)

North Side residents: 6985 Snow Way Drive, Campus Box ___________, St. Louis, MO 63130; _______________________________ (Building) (Room)

Off-campus: _________________________________________________________________________________________________

(Street Address) (City) (State) (Zip)

Phone (Cell): ______________________________________ Room/Apartment/Office (if used): ______________________________ Email address (please write legibly): _______________________________________________Hometown zip code_______________ Affiliation: Class of 2018 Class of 2017 Class of 2016 Class of 2015 Graduate/Professional Faculty/Staff School: Arts & Sciences Business Design & Visual Arts Engineering Law Medicine Social Work

Major(s): ______________________________________________________________________ Sex: Male Female Transgender Social Security Number: ________________________________ Date of Birth: ____________________________________________ Note: Social Security Numbers are required for background checks, and your application will not be considered if you omit this information. If you are an international student and you do not have a Social Security Number, please note this on the line above.

Emergency Contact: ___________________________________________________________________________________________

(Name) (Relationship) (Phone)

Background Check Authorization:

I hereby authorize Washington University, St. Louis Public Schools, and/or College Bound

St. Louis to use my personal information to conduct a background check as part of my application for Each One Teach One. I further authorize the University, St. Louis Public Schools, and/or College Bound to disclose such information and any background check results to each other as needed. I understand that I must complete this background check as a part of the application for Each One Teach One.

_______________________________________________________________ (Signature) (Date)

Are you aware of any adverse finding of abuse or neglect by the Division of Family Services? (circle) Yes No

If yes, please explain: __________________________________________________________________________________ Are you aware of any adverse finding in the criminal background check? (circle) Yes No

If yes, please explain: __________________________________________________________________________________

St. Louis Public Schools Volunteer Commitment:

As a volunteer, I agree to abide by the policies of the St. Louis Public

Schools and I confirm that all my answers to the questions in the application are accurate and complete. I understand that the acceptance of my volunteer services is contingent upon the accuracy, completeness, and acceptability of the information furnished. Permission is granted to the St. Louis Board of Education to verify all statements in this application. This permission includes the review of character references, and information from databases including Department of Corrections, court administrations, law enforcement agencies, and the Missouri Division of Family Services. In the event that there is an unfavorable response from any of these, I understand that my services may be rejected by the St. Louis Board of Education. I understand that this information will be

treated confidentially. I have read the above statement and accept the same as a condition of volunteering by the St. Louis Board of Education.

_____________________________________________________________

(Signature) (Date)

The St. Louis Board of Education does not discriminate on the basis of race, color, national origin, sex, age, religion, veteran status, creed, ancestry, sexual orientation, or disability in the admission of access to its programs and activities. Inquiries regarding compliance with Title VII, Title IX, ADEA, Section 504 of the Rehabilitation Act, the Missouri Human Rights Act, or ADA should be directed to the Human Resource Officer, 801 North 11th Street, St. Louis, MO 63101.

Volunteer

Application

For Office Use Only: Jump Start Received _________ _________ KIPP Victory SSN check _________ _________ KIPP Inspire

Interview _________ _________ College Bound – Club Rev Spreadsheet _________ _________ College Bound – OH Follow-up _________ _________ M T W Th Su

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Transportation (select one)

____ Registered for CarShare ____ Eligible for CarShare

Please visit www.parking.wustl.edu/wecar.htmto learn more & review your eligibility before submitting this form ____ Have a car of my own on campus

____ Need transportation for tutoring

Availability

Please mark an “X” in ALL boxes below when you are able to commit to tutoring.

Please provide as much flexibility as possible Monday through Thursday. Sunday tutoring slots are very limited. If you provide limited availability, it may impact our ability to place you in a program.

Time Commitment

(includes travel time) Monday Tuesday Wednesday Thursday Sunday 2:30-5:30pm

3:15-5:00pm 3:30-5:30pm 3:40-5:30pm 4:00-6:30pm 2:30-4:30pm

Additional Information

Preferred tutoring topics at the high school level (circle all that apply): Math Bio Chem Physics English Govt History Spanish French Interested in participating in Science Olympiad Coaching at KIPP: Inspire? (please circle): Yes No

How did you hear about us? (circle all that apply): Email CSO email newsletter DUC banner outside CSO Posters DUCtv Facebook Friend Info Session Activities Fair Service First/Community Service Fair Other:______________

Statement of Interest (please type on a separate page):

Each One Teach One is committed to meeting the needs of each of our program partners and providing volunteers with a

meaningful experience. Your statement(s) will help us consider which program is the best fit for you. Applicants with prior Science Olympiad coaching experience at KIPP: Inspire do not need to complete this section.

1. Please explain why you would like to tutor/mentor through Each One Teach One and what you can contribute as a volunteer. Be sure to mention previous experience working with youth, if applicable, and any other relevant experience. (maximum 300 words)

2. _____ Assign me to the program where I’m needed the most -- OR –

_____ I would prefer to tutor with a specific program. If you choose this option, please explain the reason for your preference and why you are best suited for this program. Please also indicate whether you are willing to be placed in a different program if needed. Placement requests are not guaranteed. Please specify if you would like to work with Science Olympiad at KIPP: Inspire. (maximum 300 words)

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Each One Teach One Volunteer Commitment

Each One Teach One is committed to offering an exceptional tutoring experience by delivering high quality training and preparation, transportation, tutor support and strong leadership. We value sustained partnerships, mutually beneficial service experiences, and dedicated volunteers. Our aim is to make a significant impact in the lives of St. Louis youth through our efforts and your commitment. As a volunteer, you will commit to the following responsibilities:

• Volunteer each week for a minimum of one semester • Attend tutor training at the beginning of each semester • Be present and engaged with students during tutoring

• Model appropriate behavior that aligns with the values of Washington University, the Community Service Office, and the host organization/school

• Notify EOTO Coordinator of anticipated absences at least 48 hours in advance

• Adhere to program-specific attendance policies and understand that excessive absences/tardies may require EOTO Coordinator to ask you to leave the program

• Communicate concerns and ideas to EOTO Coordinator, Day Leaders, Team Leaders, or Community Service Office staff

• Participate in continuing education opportunities, periodic tutor/mentor meetings, and other special events • Support recruitment efforts to identify new EOTO tutors and mentors

I have read and signed the Each One Teach One Volunteer Commitment Statement which outlines my responsibilities and the responsibilities of the program:

________________________________________________________________ (Signature) (Date)

Additional Expectations of Science Olympiad Coaches at KIPP: Inspire

If you have interest in the Science Olympiad option at KIPP: Inspire, please note the following additional expectations. • Volunteer each week for a minimum of two semesters.

• Prepare lesson plans before each weekly coaching session (training will be provided).

___________________________________________________________

(Signature) (Date)

Statement of Personal Responsibility & Release

I have read and signed the Statement of Personal Responsibility & Release regarding participation in WU Community Service Projects, and have noted the following:

• Potential dangers, hazards, and risks inherent to Each One Teach One (EOTO)

• Upholding behavior consistent with WU Judicial Code, WU drug and alcohol policy, and all other WU policies • FERPA consent and authorization for WU to include my name and contact information on EOTO volunteer

rosters

• FERPA consent and authorization for WU to release my Each One Teach One application materials to St. Louis Public Schools, KIPP: Inspire Academy, KIPP: Victory Academy and/or College Bound St. Louis

_________________________________________________________________ (Signature) (Date)

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Volunteer Standards of Conduct

St. Louis Public Schools

I, ______________ , a volunteer with the St. Louis Public Schools do hereby agree to maintain the following standards of conduct at all times while I serve as a volunteer with the St. Louis Public Schools:

1. I will always report immediately to the office and sign-in upon my arrival at the school; 2. I will report to the volunteer coordinator before going to my assignment;

3. I will wear my name badge where it can be easily seen;

4. I will abstain from wearing clothing which is revealing, or bares references to explicit language, sex, alcohol or tobacco;

5. I will only use the restroom which is designated for adult use; 6. I will never be alone with a student;

7. I will never break up a disruption between students or parents; rather I will promptly inform a staff member;

8. I will report any suspicion of abuse to the principal, teacher or other appropriate support staff as soon as possible;

9. I will avoid outside contact with students who I meet in my capacity as a volunteer;

10. I will notify the district representative in charge of my site in writing of any prior family, friend or otherwise familiar relationship that I have with a student that is also likely to be in the building where I am providing volunteer service;

11. In the case I have a prior or existing relationship with any student in the program or building where I am providing services, I will provide the district with a parental permission statement and a waiver of liability fully executed by the parent or guardian of the aforementioned student.

12. I will abstain from representing myself as an employee or legal agent of the St. Louis Public Schools. 13. I will not complete a student’s work for him or her;

14. I will not leave the tutoring premises with a student; 15. I will not transport a student.

I understand and agree that the violation of any of these standards of conduct may result in my immediate disqualification as a volunteer with district. I will be personally liable for any and all damages to persons or property that result from my breach of this agreement.

Respectfully submitted,

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STATEMENT OF PERSONAL RESPONSIBILITY & RELEASE REGARDING PARTICIPATION IN

WASHINGTON UNIVERSITY COMMUNITY SERVICE PROJECT

(for students aged 18 or older only)

1.

I, _________________________________________, am a student at Washington University (the

“University”).

2.

I wish to participate a University Community Service Project entitled: Each One Teach One (“Student Event”)

which may take place at a public or charter school in St. Louis city or county, at College Bound St. Louis, and/or

at Washington University in St. Louis (location), organized by the Community Service Office. I understand that

I am not required to participate in this Student Event, but am voluntarily doing so, despite the potential

dangers and risks (as described in more detail below) and despite this Release.

3.

I understand and appreciate the dangers, hazards and risks inherent to the Student Event, including but not

limited to transportation to, from, and around the Student Event area; natural disasters; inclement weather;

heat exposure; riots; dangers associated with construction areas; accidents; illnesses; crimes; and any risks

associated with independent activities I undertake as an adjunct to the Student Event, all of which could

include serious or even fatal injuries or property damage or loss. I also understand that I may visit a culturally

diverse area in connection with the Student Event where I may encounter unwelcome activity such as

inappropriate or uninvited verbal remarks and agree to conduct myself in a respectful manner and to avoid

confrontation. I further understand that the University, including the individuals acting on its behalf, cannot

and does not assume responsibility for such events or personal injuries or property damage arising there from

even if such injury or damage is a result of the negligence of the University or other parties released.

4.

Knowing the dangers, hazards and risks of the Student Event, and in consideration of being permitted to

participate in it, on behalf of myself, my family, heirs, and personal representative(s), I agree to assume all the

risks and responsibilities surrounding my participation in the Student Event and, in advance, release, waive,

forever discharge, and covenant not to sue the University, its governing board, officers, agents, employees,

students, and volunteers (collectively, the “Releasees”) from and against any and all liability for any harm,

damage, claim, demand, action, cause of action, cost or expense of any nature that I may have or that may

hereafter accrue to me, arising out of or related to any loss, damage or injury, including but not limited to

physical injury, suffering or death, that may be sustained by me or by any property belonging to me, whether

caused by the negligence or carelessness of the Releasees with regard to the Student Event. It is my express

intent that this Release shall be deemed a release, waiver, discharge and covenant not to sue the Releasees. I

further agree to save and hold harmless, indemnify, and defend Releasees from any claim by me or my family

arising out of my participation in the Student Event.

5.

I understand that I am expected to behave in a manner consistent with the Washington University Judicial

Code, the Washington University Drug and Alcohol Policy, and all other applicable University policies. I

understand that the use or possession of any illegal drugs, including marijuana, can have very grave

consequences, including arrest and imprisonment. I know that I am subject to local law and agree to obey all

laws and ordinances of jurisdictions where I may be during my participation in the Student Event.

6.

I am aware of my own personal medical needs and state that there are no health-related reasons or problems

that preclude or restrict my ability to participate safely in the Student Event. I assume all risk and

responsibility for my medical needs, and understand and agree that if I must be hospitalized or otherwise

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receive medical care; the University cannot and does not assume legal responsibility for payment of such

costs. I hereby grant permission to the Releasees to authorize emergency medical treatment for me, and

understand and agree that neither the University nor any of the other Releasees assume any responsibility for

any injury or damage that may arise out of or in connection with such authorization.

7.

FERPA CONSENT: I consent and authorize Washington University in St. Louis to release education records and

information, including but not limited to my Each One Teach One volunteer application packet, to any and all

Each One Teach One program partners where I am tutoring or applying to tutor. Specifically, I authorize the

Community Service Office to release and disclose such records and information for the purpose of reviewing

volunteer applications, submitting background checks, and maintaining rosters. I also authorize the

Community Service Office to include my name and contact information on volunteer rosters distributed to

Each One Teach One leaders and volunteers. I understand that under the Family Educational Rights and

Privacy Act, 20 USC 1232(g): (1) I have the right not to consent to the release of my education records; and

(2) I have the right to receive of copy of those records upon request. This FERPA Consent shall remain in

effect until revoked by me, in writing, and delivered to the Director of the Community Service Office at

Washington University in St. Louis, Campus Box 1059, One Brookings Drive, St. Louis, MO 63130. I

understand that any such revocation shall not affect disclosures made prior to the University’s receipt of

my written revocation.

8.

I warrant that I am at least eighteen (18) years of age and fully competent to sign this Release; that I

understand the terms contained herein are contractual and not a mere recital; that I have read this Release

with full knowledge of its significance; and that I have signed this Release as my own free act.

9.

I agree that this Release shall be construed in accordance with the laws of the State of Missouri. If any term

provision of this Release shall be held unenforceable, illegal, or in conflict with any governing law, the validity

of the remaining portions shall not otherwise be affected.

THIS IS A RELEASE OF LEGAL RIGHTS.

READ IT AND BE CERTAIN YOU UNDERSTAND IT BEFORE SIGNING.

ACCEPTED AND AGREED:

(Signature)

(Date)

(Printed Name)

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Volunteer Reference Check

St. Louis Public Schools

______________________________________has applied for volunteer service with the St. Louis Public Schools. Your name was listed as a reference, and we have been authorized to communicate with you. It will be helpful to receive the following information that will be treated confidentially.

1) How long have you known the applicant? 2) In what capacity do you know the applicant?

3) In your opinion, would this individual be a responsible and reliable participant in our school volunteer program?

4) Are you aware of any physical or emotional conditions that might be considered of potential difficulty? 5) Can you comment on the strength of this applicant?

6) Weakness?

7) On a scale of 1 to 5 (5= outstanding), please give your honest and fair appraisal of this candidate’s ability to meet the following criteria.

Poor Outstanding

Leadership 1 2 3 4 5 Unable to evaluate

Initiative 1 2 3 4 5 Unable to evaluate

Responsibility 1 2 3 4 5 Unable to evaluate

Maturity 1 2 3 4 5 Unable to evaluate

Communication 1 2 3 4 5 Unable to evaluate

Enthusiasm 1 2 3 4 5 Unable to evaluate

Cultural Sensitivity 1 2 3 4 5 Unable to evaluate

Potential for working with at-risk youth 1 2 3 4 5 Unable to evaluate 8) Any other comments or information you think might be helpful will be greatly appreciated.

________________________________________________

Signature Date

_____________________________________________________________________________________

Printed Name Address City/State/Zip

Thank you for your assistance!

Please return completed form to the prospective volunteer. You may enclose the form in a sealed envelope if you choose.

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This page is intentionally left blank. If you print the full application packet double-sided, your reference forms will appear on separate pages so that you can hand them to your references to complete.

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Volunteer Reference Check

St. Louis Public Schools

______________________________________has applied for volunteer service with the St. Louis Public Schools. Your name was listed as a reference, and we have been authorized to communicate with you. It will be helpful to receive the following information that will be treated confidentially.

1) How long have you known the applicant? 2) In what capacity do you know the applicant?

3) In your opinion, would this individual be a responsible and reliable participant in our school volunteer program?

4) Are you aware of any physical or emotional conditions that might be considered of potential difficulty? 5) Can you comment on the strength of this applicant?

6) Weakness?

7) On a scale of 1 to 5 (5 = outstanding), please give your honest and fair appraisal of this candidate’s ability to meet the following criteria.

Poor Outstanding

Leadership 1 2 3 4 5 Unable to evaluate

Initiative 1 2 3 4 5 Unable to evaluate

Responsibility 1 2 3 4 5 Unable to evaluate

Maturity 1 2 3 4 5 Unable to evaluate

Communication 1 2 3 4 5 Unable to evaluate

Enthusiasm 1 2 3 4 5 Unable to evaluate

Cultural Sensitivity 1 2 3 4 5 Unable to evaluate

Potential for working with at-risk youth 1 2 3 4 5 Unable to evaluate 8) Any other comments or information you think might be helpful will be greatly appreciated.

_____________________________________________

Signature Date

_____________________________________________________________________________________

Printed Name Address City/State/Zip

Thank you for your assistance!

Please return completed form to the prospective volunteer. You may enclose the form in a sealed envelope if you choose.

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References

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