Volunteer Background Check

We appreciate your interest in volunteering for Middlebury Community Schools! Please complete and submit a volunteer application and upon approval you will receive instructions on next steps.

It is very important that the information you enter on the application matches your government issued identification card including your full legal name. It is important that you provide a valid email address so you can be notified as to the status of your application and for future communication. If you are unable to provide an email address, you may use the provided district email address. All information collected on the application will remain confidential and will not be shared outside the volunteer program.

If you have any questions about the application, please contact Dana Clark, Director of Human Resources, at (574) 825-9425.

Thank you!

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

Please note: A message 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 clarkd@mcsin-k12.org and a district administrator will call you regarding the status.

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

By providing your signature, you are agreeing to abide by the rules and regulations of the District Volunteer Program. One or more of the volunteer activities you have selected may require you to provide your United States social security number so we can perform a criminal background check. Your social security number will only be used for this purpose and we do not retain this information.

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 per the district’s volunteer policy. In the near future, you will be notified as to your volunteer status. If you have any questions, please contact the school where you will be volunteering.