Would
you like to have someone read to you (or someone
you know)? Sign up to be a "Listening Buddy".
Please
complete all questions and submit. Once completed,
we'll work to locate a volunteer Reading Buddy.
Contact
information:
If
this form is being completed by someone OTHER than
the Listening Buddy, please provide us with your
name
and phone number here (family member or friend):
First
and Last Name of person in need of reading ("Listening
Buddy")**
Provide
phone number "Listening Buddy" is
planning to use**
City,
State/Province, Country of "Listening
Buddy"**
Calling
[choose one]:**
"Listening Buddy" HAS a free/cheap long distance
plan and can call the assigned volunteer Reading Buddy.
"Listening Buddy" DOES NOT HAVE a
free/cheap long distance plan and needs a volunteer
Reading Buddy to call.
Calling
time [choose one]:**
The
best time of the day for the "Listening
Buddy" to be read to
is:
any time
mornings
afternoons
evenings
Calling
frequency [choose one]:**
The "Listening
Buddy"
would appreciate being read to at this frequency:**
daily [weekdays only]
weekends only
7 days a week
only certain days during the week: [indicate which days in this box]
Language:**
The "Listening Buddy" would
like to be read to in this language:
English
Spanish
French
German Any
other special instructions, questions, or information:
Contact
eMail address (optional):
eMail
Address of person completing this form (if you have
one)
Re-enter
eMail Address
Once
the "submit" button below has been clicked, we will
go to work to match the "Listenging Buddy" with a
volunteer Reading Buddy. Thank you! We will be in
contact soon. |
