MSD DECATUR VOLUNTEER FORM
School Year 2016-2017
Name (First & Middle) *
Your answer
Last Name *
Your answer
Date of Birth *
Your answer
Race (Choose one of the following): *
Required
Gender *
Address *
Your answer
Email Address *
Your answer
Phone *
Your answer
Personal Reference, Relationship, and Reference Contact Info *
Your answer
Name of school your child will be attending. *
Name of school additional children attend if different from above. Choose 'None' if this doesn't apply. *
Name of school additional children attend if different from above. Choose 'None' if this doesn't apply. *
Name of school additional children attend if different from above. Choose 'None' if this doesn't apply. *
Name of school additional children attend if different from above. Choose 'None' if this doesn't apply. *
Student Name (s), Teachers and Grade Levels. *
Your answer
Community Member/College Student
What type of volunteering would you like to do?
Your answer
If you are a relative to a MSD Decatur Staff member please answer the following: Staff Member Name/Relation/School *
Your answer
Where would you like to volunteer and what type of activities are you interested in? *
Your answer
If there is an issue that you believe may be presented on the back ground check that you would like to explain, please do so now. Have you ever been arrested for or convicted of a crime that has not been expunged by a court? This information will be considered confidential and will only be viewed by those involved in the approval process. *
Your answer
Please note that the information received will be used to determine your eligibility as a suitable volunteer for the MSD of Decatur Township Schools. All information received is considered “confidential” , and will only be viewed by a select group of employees who have been assigned the task of determining eligibility. You may request at any time a copy of what was used to determine your eligibility, as well as information detailing policies and procedures pertaining to what is considered “confidential” and how your information is protected. Also note that the process of determining a volunteers’ eligibility with the MSD of Decatur Township Schools will be conducted yearly, included in this process will be written permission from the volunteer to conduct security checks. *
Initial and Date (This will serve as your electronic signature that all information is correct)
Your answer
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