| Celebrity Read 2012 Volunteer Form |
| Name * |
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| Address * |
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| Best Telephone Number to Reach You * |
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| Cell Phone |
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| Email * |
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| Best Way to Reach You |
telephone
cell phone
email
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| Which service area(s) would you like to read in East Orange? |
Banjamin Banneker – Feb 10
Johnnie Cochran – Feb 15
Dionne Warwick Institute – Feb 29
Select all that you are interested in.
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| Which service area would you like to read in Harrison? |
Lincoln School - Feb 28
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| Which service area(s) would you like to read in Irvington? |
Madison Ave. – Feb 3
Chancellor Ave.- Feb 8
University Elementary – Feb 10
Mount Vernon Ave.- Feb 22
Select all that you are interested in.
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| Which service area(s) would you like to read in Maplewood/South Orange? |
Clinton School -Feb 17
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| Which service area(s) would you like to read in Newark? |
Branch Brook Elementary – Feb 24
BRICK Avon Academy – Feb 16
Broadway – Feb 27
Camden St. School – Feb 23
Dayton St.- Feb 9
Harriet Tubman – Feb 17
Flagg Elementary – Feb 14
Martin Luther King Jr. – Feb9
Select all that you are interested in.
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| Which service area(s) would you like to read in Nutley? |
Lincoln School -Feb 8
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| Which service area(s) would you like to read in Orange? |
Rosa Parks Central – Feb 29
Park Avenue - Feb 16
Select all that you are interested in.
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| I would like to read … |
Wherever I am
most needed
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| Is there a particular program you would like to volunteer for? |
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| How did you hear about our Celebrity Read program? |
Family
Friend
Co-worker
Brochure
United Way
Website
Other
Social Service Organization
Celebrity Read
Event
Other Referral
Source
Select all that apply.
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| Have you been a Celebrity Read Volunteer in the past? |
Yes
No
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