Pleasanton Unified School District Volunteer Clearance Application

PUSD volunteers are an invaluable resource to our teachers and students. Each year, volunteers enhance the educational experience for students by helping in classrooms, chaperoning field trips, assisting with extra-curricular activities, serving as assistant club advisors, and supporting our programs by transporting our students to & from activities.

The Pleasanton Unified School District Volunteer Program includes several levels of volunteer clearance and tracking. We ask that the level of clearance you choose is based on the volunteer activities that you plan to sign up for during the 2024 - 2025 school year.

Prior to filling out this application, please review the volunteer clearance information on the Volunteers page of the PUSD website to determine whether you should apply to be a Level 1, Level 2, or Level 3 volunteer.

Important Reminders:

The information you enter on the application must match your government-issued identification card including your full legal name.
- Please note: Returning volunteers should enter their name exactly as it currently appears in the Raptor System. If you aren’t sure how you should enter your name when applying, please email volunteerclearance@pleasantonusd.net.

You must provide a valid email address so you can be notified as to the status of your application and for future communication.
All information collected on the application will remain confidential and will not be shared outside the volunteer program.
Have your TB clearance verification available at the time of application.
If applicable, have your completed Driver Transportation Form and Auto Insurance Coverage Declaration Page available at the time of application.
This application should be filled out using a laptop or desktop computer rather than a mobile device as this application is not yet mobile optimized.
Please allow about 10-15 minutes for completion as THIS APPLICATION WILL NOT SAVE IF NOT COMPLETED IN ONE SITTING.

If you have any questions about this application, please email volunteerclearance@pleasantonusd.net.

Thank you,

Volunteer Clearance Team

Pleasanton Unified School District

Personal Information

Legal First Name

Address Line 1

Legal Middle Name

I don't have a middle name

Address Line 2 / Apt # / Building #

Legal Last Name

City

Maiden Name

State/Province/Region

Gender

Postal/Zip Code

Date Of Birth

Phone Number Phone number is required

Affiliation

Preferred Language (for future communications)

Please note: An email will be sent to the email address entered to inform you of the status of your application. If you do not have access to email, please enter volunteerclearance@pleasantonusd.net and a district administrator will call you regarding the status.

Please select the schools at which you wish to volunteer

Functions: Please make one selection — Level 1, Level 2 or Level 3 — based on your anticipated volunteer activities for the 2024 - 2025 school year

Required Documents

Level 1, Level 2 & Level 3 applicants are REQUIRED to upload TB Clearance Verification prior to submitting this application:

Submit ONE of the following forms of TB Clearance documentation from a healthcare provider:

A TB risk assessment certificate of completion
A negative TB skin test result*
A statement from your healthcare provider that you are free of active TB infection

Documentation needs to be from a licensed healthcare provider within the last three years and must include the date, volunteer’s name, volunteer’s date of birth, and the healthcare provider’s

contact information.

*A TB skin test may NOT be recommended for individuals who have previously tested positive for TB and/or received a BCG vaccination against TB. Please consult your healthcare provider for further instruction.

Level 3 applicants must submit their Driver Transportation Form and Auto Insurance Coverage Declaration Page to be cleared to transport students in a private vehicle. It is recommended that these documents are uploaded on this page at the time of application.

Minimum liability insurance requirements:

Bodily injury - at least $100,000/$300,000
Property damage - at least $25,000
Medical payment per occurrence - at least $5,000
Uninsured motorist coverage at least $100,000/$300,000

Please select the organization(s) on behalf of which you are volunteering (if not applicable, select "None")

Please read the confidentiality statement below and provide your signature

By providing my signature, I acknowledge and agree that:

1. In the course of my volunteer association with the Pleasanton Unified School District (“PUSD”) or any independent support entities (including, without limitation, PTAs, PTSAs, PFCs, PPIE, music/athletic boosters and other parental groups; collectively, “Supporters”), I share the responsibility of maintaining student, employee, PUSD and Supporter confidentiality as to any information, whether written, verbal or by actions observed, which I may have available to me.

2. 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 may result in the termination of my volunteer involvement with PUSD or Supporters.

3. I do not become an employee or agent of PUSD or Supporters as a result of my volunteer association; while PUSD and Supporters attempt to conduct events and events using reasonable safety measures, they have not undertaken any specific duty or responsibility for my safety and will be held harmless for all acts or omissions other than for its gross negligence. PUSD and Supporters are independent entities which assume no duties, responsibilities or liabilities of the other.

4. I may be photographed for PUSD or Supporter marketing, news articles, yearbooks or other related purposes.

5. The information entered into this volunteer application will be stored in a centralized database accessible by every PUSD school site.

Name

Signature

By signing your name you agree to all the above statements. Use the mouse or touch screen to sign.

Thank You

Your volunteer application has been successfully submitted and will be reviewed by the PUSD Volunteer Clearance Team. In the near future, you will be notified as to your volunteer status.

Please remember to keep your TB clearance verification documentation since you will have to upload the same file when you apply to volunteer in future years.