Portland Public Schools Student Volunteer Application
Please complete this form to volunteer in PPS if you are under 18 years of age. 
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Name *
Birthdate *
email address *
mailing address *
cell phone # *
school attending and current grade level *
Teacher/counselor reference- please include their name and email address *
Teacher/counselor reference- please include their name and email address- this one is optional
Please list days and times that you are available to volunteer. Please note that our students are released 1 hour earlier on Wednesday afternoons *
Please list any preferences you may have for volunteering: grade level and/or
Please select a school or program: *
Emergency contact- please include name, phone number and relationship to you *
I grant PPS permission to use my likeness, voice and words in television, radio, film or in any form to promote school activities *
Student Privacy and Volunteer Confidentiality Students in the Portland Public Schools have the right to expect that information about them will be kept confidential by all  volunteers. Additionally, the U.S. congress has addressed the privacy-related concerns of educators, parents, and students by enacting  the Family Educational Rights and Privacy Act (known more commonly as “FERPA” or the “Buckley Amendment”). Among other  provisions, FERPA allows the government to withdraw federal funds from any educational institution, including the Portland Public Schools,  which disseminates a student’s education records without his or her parent’s consent. ∙ Each student with whom you work has the right to expect that nothing that happens to or about him or her will be repeated to  anyone other than authorized school department employees, as designated by the administrators at your school. Even when  discussing a student with those who are directly involved in a student’s education, such as a teacher, principal, or guidance  counselor, you may not share otherwise confidential information with them unless it is relevant to the student’s educational  growth, safety, or well-being. ∙ You may not share information about a student even with others who are genuinely interested in the student’s welfare, such as  social workers, scout leaders, clergy, or nurses/physicians (a grave medical emergency, in which confidential information may be  necessary for a student’s care, is the only exception). Thus, you must refer all such questions to the school employees so  authorized and indicated to you, typically the student’s teacher or principal. ∙ Parents, friends, or community members may in good faith ask you questions about a student’s problems or progress. Again,  you must refer all such questions to the authorized school employees. You may not share information about a student even with  members of you own family or the student’s family. ∙ Before you speak, always remember that violating a student’s confidentiality isn’t just impolite, it’s against the law! Agreement I, (print name)______________________________, as a volunteer for Portland Public Schools agree never to disclose  information about a student’s records to anyone other than an authorized school department employee. I will refer all requests for  such information from those not directly involved in the student’s education to authorized school department employees. Signature Date _________________________ Please type in your name below to act as your signature. *
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