MSCA: Volunteer Registration Form

Volunteer Registration

If you are considering volunteering your time, skills and experience to support your local school as a MOUSE Squad Volunteer, please fill out the form below and a MOUSE Squad of California representative will contact you shortly.

Your Name:	First	Last
Your Address:	Street	City	ZIP
Employer and position or function:	Employer	Your Position/Title	(Enter "None" and "Retired" if appropriate)
Contact Email:
Contact Phone:
Best time/method to contact you:

Why do you want to volunteer with the MOUSE Squad program?

The program is usually Monday through Friday from 8 AM to 6 PM. What is your availability (check all that apply)?
AM PM Late PM
Monday Tuesday Wednesday Thursday Friday Saturday
It's more complex than this. Contact me.
What operating system do you prefer?
A Mac site A Windows site It doesn't matter to me

What grade level (ages) do you prefer (check all that apply)?
Elementary (5-10) Middle (11-13) High School (14-18)
What is your preferred city or cities, if any?

What are your technical and/or educational skills you feel are relevant?

What is your previous experience, if any, with youth or volunteer groups (i.e., clubs, churches, synagogues, service groups, etc.)?

What are your interests (technical or otherwise)?

Please indicate what languages you speak.

How did you hear about the MOUSE Squad program (if from another website, please identify it)?

Any additional comments?

Please enter this Validation Number.

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