Volunteer Instructor Candidate Profile and Information Form

Instructor Information

First Name*

Last Name*

Phone (Day)

Phone (Night)

Email*

Address*

Street Address City State ZIP Code

County of Residence*

Have you ever been accused/convicted of a felony?*

Yes

Would you be willing to submit to a background check?*

Yes

What is your highest education attained?*

What is your T-Shirt Size?*

Do you have Experience in Volunteer Settings?*

Yes

Please describe your Experience(s) in Volunteer Settings.

Please describe your Experience(s) in Disaster Preparedness and Relief Settings.

Please describe your Experience(s) in coaching/mentoring/teaching and/or working with Youth (ages 13-19), including how long and what size groups.

Please describe your Experience in Leadership Development programs.

How does this Volunteer Opportunity fit within your current life/work schedule?

What have you enjoyed most about previous Volunteer Experience(s)?

Why are you interested in MyPI?

How did you hear about MyPI?

What are your hobbies and interests?

What would you like to gain from an experience as a MyPI instructor?

What do you feel you can contribute the most to MyPI?

10 Week Commitment

MyPI Instructors have to make at least a 10 week commitment to teach one “wave”. However, they are given the opportunity and encouraged to commit to more than one “wave” a year. There are three “waves” offered per year.

I can make one 10 week commitment

I can make two 10 week commitments

I can make three 10 week commitments

Would you travel to an adjacent city/county for your program?

Typically, MyPI instructors will teach in the communities where they reside. However, there may be opportunities in the future to teach in an adjacent community.

Yes

What would you like to know about MyPI?

Profiles will be evaluated by the MyPI Steering Committee. Early submission of MyPI Volunteer Instructor Candidate Profile and Information Form is strongly encouraged.

In addition to submitting online, you may also return completed MyPI Volunteer Instructor Candidate Profile and Information Form to any of the following.

U.S. Mail
MyPI Utah, the Utah Youth Preparedness Initiative
c/o Dr. Michael L. Pate
College of Agriculture and Applied Sciences
Utah State University
2300 Old Main Hill
Logan, UT 84322

Email
Dr. Michael Pate
michael.pate@usu.edu

Name

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