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We are working to establish a data base of persons willing and able to assist our Samoan students in Grade School, Junior High School, and High School in their studies. We are soliciting your assistance as volunteers who will donate time to assist these children.

We have a special need in the Utah Valley area. If you can devote only one hour per week, your assistance is needed and will be greatly appreciated.

Please enter all of your personal information in the form below in order that you may be contacted for opportunities to assist local students. This information will remain confidential and will be used ONLY for contacting you regarding your willingness to provide volunteer service to assist students.

When you have completed filling out the form information, press the "SUBMIT INFORMATION" button at the bottom of the page.

Name:

First	Last

CURRENT INFORMATION
Address line 1:

Address line 2:

City:

State:

Zip Code:

Phone:

Cell Phone:

Current E-mail Address: (Only one please)

Current Occupation:

Type of Vounteer Service Available:

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Email comments and suggestions to Jerry Sherwood (siberiasam@gmail.com)
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