Please read the information below and provide your signature.
APPLICANT TESTIMONY – RELEASE FOR VERIFYING BACKGROUND INFORMATION
As a condition for volunteering in Academy District 20, a background check is required. Please note that some volunteer opportunities may require fingerprinting. To conduct this review, it is mandatory to provide your date of birth.
I hereby certify that the information contained in this Volunteer Application is true and correct to the best of my knowledge. I agree to have any of the information checked by the school district. I authorize the references listed, as well as any other individuals whom the district contacts (including my current employer, former employers, and any government or law enforcement agency), to provide Academy District 20, any and all information concerning my previous or current employment. I understand that if I limit the district’s right to contact persons/organizations deemed necessary by the district, the request to volunteer may not be considered further. Also, I release all parties and persons from any and all liability for any damages that may result as a consequence of furnishing such information to the district or any of its agents, staff members, or representatives for purposes related to this form or my request to volunteer. If I feel there are errors or inaccuracies in my FBI/CBI record, I will contact a Director for Human Resources. I understand that ANY misrepresentation, falsification, or material omission of information on this form may result in my being denied the opportunity to volunteer in Academy District 20. I understand these forms are kept on file and will remain the property of Academy District 20.
Academy District 20 Volunteer Confidentiality Agreement
Confidentiality of Student Records: In accordance with Academy District 20 Administrative Policy JRA/JRC, all student records are considered to be of a confidential nature and all Academy 20 staff need to ensure the confidentiality of information not be shared with students, or the public, without the written consent of parents or other authorized entity. The building principal is the official custodian of student education records in his or her building, and all inquiries regarding student records needs to be directed to the building principal. Administrative Policy JRA/JRC can be read on the internet on the district website at www.asd20.org.
Academy District 20 staff should take appropriate steps to protect the privacy of students. Allowing students or others access to student’s grades, discipline records, IEP’s, 504 Plans, or related private information may violate the requirements of the Family Educational Rights and Privacy Act (FERPA) regarding personally identifiable information. Student phone numbers and addresses are also to remain confidential. In order to safeguard students’ rights under FERPA, the following rules must be observed by district staff when working with volunteers or student assistants in the classroom.
- Volunteers and/or student assistants do not hand back assignments to students in the class where grades are visible.
- Volunteers or student assistants do not grade student work.
- Volunteers and/or student assistants shall not enter grades into the teacher’s gradebook, electronic or otherwise.
Some documents shall never be seen or handled by anyone other than the appropriate school personnel. These documents include Teacher’s Grade Book or Record Child Abuse Reports, Department of Human Services (DHS) Reports, 504 Evaluations, Disciplinary Files, Special Education Records, Permanent School Records (cum files) Health/Medical Records. Information received or observed regarding individual students must remain confidential and their privacy rights maintained at all times.
CONFIDENTIALITY AGREEMENT
I have read the above information, understand it, and agree to abide by the confidentiality requirements stated above.
By providing your signature, you are agreeing to abide by the expectations and policies of volunteering with Academy District 20. 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.