Pleasanton Unified School District 2019-2020 Volunteer Clearance Form
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This form must be submitted each school year.
CA Driver's License # *
CA
Parent's Last Name *
Parent's First Name *
Date of Birth (Parent) *
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Gender *
Address - Street # and Name *
Address - City, State and Zip Code *
Phone Number (including area code) *
School Sites of your children
Signature
By typing my name, I authorize the Pleasanton Unified School District to submit this information to the Pleasanton Police Department to complete the volunteer screening process.
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Date *
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Optional
Donation to cover the cost of Volunteer Screening - For your reference, it cost the District $6.00 to conduct a clearance check. If you would like to cover this cost, kindly make your check payable to Pleasanton Unified School District and drop off in the Main Office of your student's school site.
Confidentiality Statement
By typing my name, I understand that in the course of my volunteer association with the Pleasanton Unified School District, I share the responsibility of maintaining student, employee and District confidentiality as to any information, whether written, verbal or by actions observed, which I may have available to me. I further understand that in the course and scope of my volunteer status, I am not to discuss academic, social or other confidential information regarding students or school employees with anyone, including the parents of any student. Any breach of confidentiality will be carefully reviewed by Pleasanton Unified School District and, if substantiated, may result in the termination of my volunteer involvement with the School District. By typing my name, I am also authorizing the Pleasanton Police Department to access criminal history information pertaining to me and determine under Education Code (EC) 35021 any information which would disqualify my application for volunteer position(s). The School District office will be notified by Pleasanton Police Department of the applicant’s clearance status as “Cleared” or “Not Cleared.
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Date *
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Submit
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