Chesterfield County Public Schools Volunteer Application

**NOTE: THIS FORM IS NOT CELL PHONE FRIENDLY; IF YOU MUST USE A CELL PHONE, PLEASE TURN IT LONGWAYS IN ORDER FOR THE FROM TO DISPLAY PROPERLY**

Welcome and thank you for your interest in becoming a volunteer in our schools. The School Board encourages parents and other community members to volunteer and appreciates the time dedicated to our students and schools.

If you are looking to volunteer in any capacity to include but not limited to chaperone, classroom helper, office helper, mentor , please fill out the following form and disclaimer. There is a minimum turn around of 2 weeks for submitted application.

Please refer to our Volunteer School Board Policy 3070 for more details regarding volunteers in our schools. Please read the disclaimer here and on page 6 carefully; once you sign page 6 and move to the next page; there is a link to allow you to list any misdemeanors or felonies.

You will not be approved if 1) it is found that you have not included all criminal convictions and pending charges; 2) you have any misdemeanor convictions of any type within the past 12 months; 3) you have any misdemeanor convictions for crimes of violence, child abuse/neglect, or sex or obscenity offenses at any time; 4) you have any felony convictions involving violence, child abuse/neglect, or sex/obscenity offenses at any time; 5) you have any other felony convictions for which I have not had my rights restored by the governor.

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)

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Please select the schools at which you wish to volunteer

Please select the functions from the list below. (select all that apply)

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

Please read the disclaimer below and provide your signature

I understand and agree that (1) I am not obligated if called upon to perform the volunteer services applied for; (2) additional information may be requested; and (3) CCPS reserves the right at all times to decline to use me as a volunteer and to terminate my service at any time

I understand that I must list all criminal convictions and pending charges, and that I will not be permitted to volunteer in a school if: 1) it is found that I have not included all civil/criminal convictions and pending charges; 2) I have any misdemeanor convictions of any type within the past 12 months-this inlcudes current court cases; 3) I have any misdemeanor convictions for crimes of violence, child abuse/neglect, or sex or obscenity offenses at any time; 4) I have any felony convictions involving violence, child abuse/neglect, or sex/obscenity offenses at any time; 5) I have any other felony convictions for which I have not had my rights restored by the governor- a copy of the letter is required.

Further, I understand that I may have access to personal, sensitive, or confidential information about students and staff during my service as a volunteer, and agree that I will not inappropriately share any such information in any manner with any person. Further, I confirm that I have read and will comply with Board Policies 3070, 6133, as well as all other applicable policies, regulations and procedures. (All Board policies and regulations may be found on the school division’s website at www.mychesterfieldschools.com)

If you have any misdemeanors/felonies, please provide the information using the Criminal Disclosure Form

Finally, I declare that all of the statements made in this application are true, complete and correct to the best of my knowledge and belief.

Name

Signature

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

Thank You

Thank you for submitting your application; it is pending review and you will be notified via email of your status.

If you have any misdemeanors/felonies, please provide the information using the Misdemeanor Form

If you have any felonies, please send letter of rights restored to volunteer@ccpsnet.net.

*Applications can take up to a minimum of 2 weeks for processing

*Approval emails are computer generated coming from "no-reply@raptortech.com"; this could cause your email program to mark it as spam

*If you did not disclose any offenses you have, please resubmit

*Any questions or concerns? Email: volunteer@ccpsnet.net; Phone: 804-639-7089