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Personal Information

Name
Email
Address
City
State
Zip
Home Phone	Format: xxx-xxx-xxxx
Office Phone	Format: xxx-xxx-xxxx
Organization that you represent

Personal Reference

Name
Relationship
Address	Please include: Street, City, State, Zip
Phone	Format: xxx-xxx-xxxx

Reading Information: Neighborhood Art House

Reading is Monday, Tuesday, Wednesday, or Thursday from 3:00pm - 3:45pm and from 3:45pm - 4:30pm

When would you like to be a 'reading pal'?	Fall 2011: Sep. 6 - Dec. 13 Winter/Spring 2012: Jan. 3 - May 14 check all that apply
What days and times?	Monday 3:00-3:45 Monday 3:45-4:30 Tuesday 3:00-3:45 Tuesday 3:45-4:30 Wednesday 3:00-3:45 Wednesday 3:45-4:30 Thursday 3:00-3:45 Thursday 3:45-4:30

Summer 2012 Reading Information: Neighborhood Art House

Summer Reading is Monday-Friday (Thursday for some weeks) from 12:05-12:35pm

When would you like to be a 'reading pal'?	Week 1: June 25 - June 29 Week 2: July 2 - 6 (Closed July 4th) Week 3: July 9 - 13 Week 4: July 16 - 20 Week 5: July 23 - 26 check all that apply

For students

I will not be able to read on the following days (fall break, etc.)	List the dates

I will have accumulated my needed volunteer hours by
Intend to read after that date	YesNo

For other readers

I will not be available on	List day(s)

*Do you like reading to children? Would you like to share your love of reading with boys and girls who attend McKinley Elementary School, The Neighborhood Art House or St. John/Holy Rosary School? McKinley is a public school where 95% of the children come from families that are under the poverty line (It is located at the corner of 22nd and Perry Street and 22nd -- 922 East 22nd St.); The Art House is an arts experience for East side inner-city children sponsored by the Benedictine Sisters of Erie (It is located at the corner of 10th and Holland Street -- 201 East 10th St.); St. John/Holy Rosary is a catholic school (It is located at the corner of 27th and Wallace Street -- 504 East 27th St.). Would you like to be a reading pal to one of these children? *

If you answered "yes" to the questions above, please fill out the form to the left. Note that you have several options - you may read during fall, winter/spring, or (at the Art House) during the summer.

Hooked on Books was originally designed to provide a reader for each individual child who chooses to enroll in the program. However, the program has become so popular at some of the locations that it is sometimes impossible to provide enough volunteer readers for each child. Consequently, we are asking volunteers to indicate if they will be willing to read to more than one child and to tell us how many children they would be willing to read to.

We would also like you to provide, as far as possible, information about absences that you can foresee during the semester.