Sign up to volunteer for CCSU 2016-2017 Registration Expectations for Volunteers 1. About You * Full Name First Name Middle Initials Last Name Alternate Name Other names you may have used ( eg. nicknames, maiden) Alternate First Name Alternate Last Name Street Address City State Zip Code Primary Phone Secondary Phone Work Phone Email Address Date of Birth: month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year(xxxx) 2 . Do you have any relation to a student enrolled at our school?* Yes (if Yes, please provide following information) Child First Name Child Last Name Your Relationship to Child 3. Please check the location you are interested in volunteering your services to* SummitADL MiddleFlemingHiawathaWestfordEssex HighCenter for TechnologyEssex ElementaryEssex MiddleCentral OfficeFounders Memorial School Contact Person 4. Please indicate the type(s) of service(s) you wish to volunteer for* Library Support Clerical Support Chaperoning Classroom Support Event Organization Student Activity Advisor Coaching Student Mentor Other: As a confirmation please write this security code: By selecting the "Submit" button, I agree to "Acknowledgement and Authorization" below: When you apply to be a CCSU volunteer, we send you an email to the email address you provided. This email has a link inside of it that you'll need to click to confirm your application. If you can't find this email, let us know. Acknowledgement and Authorization I understand that the district will be conducting a criminal record check with the Vermont Criminal Information Center (VCIC). I understand that I will automatically be disqualified from volunteering if I was convicted of any of the crimes found on http://www.ccsuvt.org/human-resources/volunteers/. I understand that this is not an all inclusive list of disqualifying crimes: Other crimes and the totality of crimes shall be considered on a case-by-case basis. In the event the District receives notice of a criminal record, I understand that within 30 days of receiving the results of the record check, I have the right to appeal the findings to the Vermont Criminal Information Center, Department of Public Safety, 103 South Main Street, Waterbury, Vermont, 05671-2101. In addition to the above disqualification, I understand that it is the responsibility of the Principal/Director or his/her designee to accept/not accept specific individuals as volunteers, and all decisions related to the continuation of a volunteer's service. I further understand that the decision of the Principal/Director on these matters is considered final. I understand that I am expected to abide by all school and Chittenden Central Supervisory Union policies and procedures which can be found at www.ccsuvt.org. I also acknowledge that I have read and understand the expectations for volunteers found on http://www.ccsuvt.org/human-resources/volunteers/. I hereby acknowledge and agree to a check of any record of criminal convictions from the Vermont Criminal Information Center. I understand that the results of this check will be made available to Chittenden Central Supervisory Union for use in reviewing my suitability for volunteer services with the district and that my volunteer service is contingent upon a satisfactory criminal records check. Title 20, Chapter 117, Section 2064 also allows an educational facility to receive conviction information on any criminal record with applicant permission during the course of volunteering. My agreement above gives permission to CCSU to receive updates to my criminal conviction record via VCIC's subscription service.