STEP 1: Complete Registration Form Apply to be a Reading Buddy by completing the application below. Once you've submitted the form you will receive an email confirmation and we'll do our best to contact you within 48 hours. 1 Start 2 Complete First Name * Last Name * Address 1 Address 2 City State ZIP Code * Home Phone Work Phone Cell Phone Email Address * Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002 Gender Male Female Emergency Contact Name Emergency Contact Phone Number School or School District of Interest Day of Week or Time of Day Preference Choose Your Orientation Date Orientation Dates Right now we do not have orientation dates. Please submit this form and we'll put you on a waiting list. How did you hear about the Reading Buddies program? Comments/Questions CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.