Volunteers - Volunteer Form

Volunteer Application
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Leon School Volunteer Program

2757 West Pensacola Street, Tallahassee, FL 32304
Phone: (850) 487-7800 • FAX: (850) 487-7886

Thank you for your interest in becoming a volunteer with Leon County Schools. We are delighted to process your application to volunteer with Leon County Schools! Completion of this form is required annually for a volunteer to be eligible for volunteer placement and Worker's Compensation coverage for accidents which occur while performing assigned school volunteer activities. Thank you for offering your time, talents and skills to enhance the education of our students! Note: LCS Volunteer Application expires annually (on June 30^th) and must be renewed each year.

Florida Retirement System (FRS) Retirees-If you are a retiree from FRS and have been retired less than one year, you must call FRS to confirm your eligibility to volunteer. Please call (844) 377-1888 and ask for the Enrollment Department. Once you confirm that you are eligible to volunteer, you can complete the volunteer application below.

Fields marked with a red * are required.

Volunteer Interests
Type of volunteer work preferred.	Schools (Pick up to 5)	Special program or group you are representing or serving
Volunteer Individual
First Name	MI	Last Name
Birth Month (i.e. 09)	Birth Day (i.e. 05)	Birth Year (i.e. 1955)
Maiden/Other Name	Gender	Age Range
Mailing Address Volunteers are subject to Florida's Sunshine Laws unless the individual notifies the district that they are exempt per Florida Statute 119.071. If an applicant is exempt, it is recommended that their employer’s mailing address and phone number is listed, as well as, their work e-mail address for their contact information. Are you exempt under Florida Statute 119.071?
Street		Apartment Number
City	State	Zip
Contact Information
Primary Phone	Work Phone (with area code)	Alternate Phone (with area code
Email Address (Important School Communication Tool)
Emergency Contact Information
Name		Phone (with area code)
Affiliations & Other Information
Are you a parent/guardian/family member of (a) student(s) in this school? Yes No		Student Name(s) and Teacher(s)/Grade(s)
Languages spoken other than English? Yes No		Which languages?
I am college student. Yes No		College Name
Security / Background
Have you ever been convicted or had adjudication withheld, or have charges pending for a criminal offense? Convicted means there has been a determination of guilt as a result of a trial or entry of a plea of guilty or nolo contendere, regardless of whether adjudication is withheld.(F.S. 943.0435). Yes No
If you selected 'YES' to any of the above questions, please provide an explanation of the charges below, the city and state arrested, date arrested, charges, and disposition. In addition, this volunteer application will need to be reviewed and approved by Leon County School District Office before volunteer service can begin.
IMPORTANT VOLUNTEER POLICIES AND GUIDELINES
All volunteers must sign in at the school office before proceeding to their volunteer assignment. Pre-school children should not accompany volunteers. Volunteers who are not working under direct supervision of a Leon County Schools’ staff member must undergo and pass a Level 2 background check, which includes fingerprinting at the volunteer’s expense. Please check with the school for the fingerprinting paperwork pursuant to Florida Statute 435.12. Volunteers are required to follow staff directions in the event of a fire drill, lock out, or emergrency drill. Volunteers may not dispense any medications (prescription or over-the-counter) to students. Volunteers may not administer any form of corporal (physical) punishment to students. Volunteers must respect a student’s right to confidentiality (Florida Statute 1002.22) including the following areas: standardized test scores, grades, attendance records, health information, academic work completed, family background information, reports of serious behavior patterns and written teacher observations. I understand that according to state law (Florida Statue 1002.22) I must protect the confidentiality of my student at all times except when: I feel he/she is showing signs of depression and possible suicide; He/she indicates a desire to do harm to another individual; I see/hear signs of possible neglect or abuse; I see/observe signs of drug abuse, or I see or a student reveals that they are seriously ill. In all of the examples above, the best course of action to take is to notify school staff immediately, and in the case of suspected child abuse, neglect, or abandonment, I am expected to call the Florida Child Abuse Hotline (1-800-96-ABUSE). School Board Policy 2430.01 - Volunteer Program, requires that a National Sexual Offender/Predator Check be processed on all school volunteers. I have read and understand the above guidelines.
Volunteer Signature / Attestation
By signing this document, I certify that all the information contained herein is true and accurate. My signature further certifies that there is no falsification of any information, omission of any information requested, or any misrepresentation. By submitting this application, I agree to abide by the policies and/or procedures of the School Board of Leon County, Florida, of the Leon School Volunteer Program and of the individual school in which I serve. I understand that Leon County Schools reserves the right to accept, decline or discontinue the services of any volunteer. I further understand that the information submitted on this application may be subject to release under the Florida Public Records Act.
Volunteer Applicant Signature (Type your full name here.)		Signature Date
Field Trip Chaperone Information Please note all field trip chaperones will be required to undergo and pass a level 2 clearance with fingerprinting at the cost of the volunteer. The cost is $61.00 and fingerprints are good for 5 years. If you are selected by the school to serve as a field trip chaperone, the school will give you the fingerprinting paperwork. School Administration reserves the right to make the final decision for chaperone selection. All fingerprinting must occur 6 weeks before the field trip to allow time for processing.
Would you like to serve as a field trip chaperone? Yes No	Have you been fingerprinted for Leon County Schools Yes No
Primary School	Additional Schools (Pick up to 3)
FIELD TRIP CHAPERONE AGREEMENT FORM
Guidelines for Field Trip Chaperones: If the chaperone has any concerns or questions during the field trip, the chaperone must immediately consult the field trip supervisor. All chaperones must attend all training sessions provided by the school. All chaperones must be 21 years of age. All chaperones must dress appropriately. Chaperones must be in actual supervision of all students assigned to them at all times, unless other arrangements ensuring the safety of students containing adequate safeguards are in place that is specifically approved by the Principal, Director, and Assistant Superintendent, and Superintendent. Trip Sponsors must clearly attach documentation to the Field Trip Authorization Form requesting permission for approval of other adequate arrangements if chaperones are not in constant supervision of students assigned to them. Approved trips must inform and obtain parental consent that students will not be under constant supervision. The entire group must stay together at all times, unless approved on the Trip Authorization form. Follow the planned timeline and itinerary. Chaperones are not permitted to use tobacco products of any kind, consume alcoholic beverages, or use illegal drugs during the field trip. Chaperones must not use profane or inappropriate language. Chaperones should not buy drinks, snacks, treats, or souvenirs for their group. Chaperones should not ask another chaperone to supervise their group. Chaperones are not permitted to bring siblings of participating students or other persons on the field trip. Chaperones are required to report any illness of students to the field trip supervisor/sponsor immediately. Chaperones must protect the confidentiality of all students according to Florida Statute 1002.22, except when: The chaperone feels the student is showing signs of depression and possible suicide; The student indicates a desire to do harm to another individual; The chaperone observes signs of drug abuse; or The student reveals that they are seriously ill. In the examples above, the proper course of action is to notify the field trip supervisor/sponsor immediately. If a chaperone suspects child abuse, abandonment, or neglect, they are required to report suspected abuse to the DCF Child Abuse Hotline (1-800-96-ABUSE). Failure to immediately report may subject a chaperone to criminal prosecution. Reporting to the field trip sponsor or school administrator alone does not satisfy the requirement of the law. Chaperones are required to call 911 in extreme emergencies and remain calm. Chaperones are not to administer any medication to students. Chaperones are not to administer any kind of verbal or corporal punishment to students. I have read and understand the above guidelines.
Chaperone Signature / Attestation
I understand and will abide by the guidelines for chaperones and will comply with the Leon County Procedures set forth for field trip chaperones.
Field Trip Chaperone Applicant Signature (Type your full name here.)		Chaperone Signature Date
Mentor Information - If you are a new/returning mentor, please complete the mentor informaton below. Please note that this volunteer application form is not for Mentor Coaches. If you are interested in becoming a mentor coach, please contact Student Activities at 850-487-7175.
Would you like to serve as a weekly mentor? Yes No	I am a returning mentor Yes No	Have you been fingerprinted for Leon County Schools Yes No
Mentor Program(s) I will serve. Please check LCS Mentor Program unless you are working on behalf of one of the organizations listed. If Other is selected above, enter organization name	Primary School	Additional Schools (Pick up to 3)
MENTOR AGREEMENT FORM
Leon County Schools’ definition of an official mentor/tutor relationship is as follows: The volunteer works in an organized, coordinated Mentor/Tutor Program; The volunteer reports to an appointed, trained Mentor/Tutor Coordinator; The volunteer receives specific training before providing mentor services to a student; The volunteer has been approved by both state and national background checks required by LCS; The volunteer works with the same student or group of students on a weekly basis for at least 12 weeks or one semester, and; Records are kept regarding the mentor/student matches and number of mentor visits made. Special Information: An approved mentor is allowed to work with their student outside of the classroom, in an open setting, away from teacher supervision, but where other school staff/adults can observe them. The Mentor/Tutor Coordinator is expected to provide the mentors with specific training, keep accurate records on the mentors serving in their school, record the number of mentor hours donated and visits students receive and the progress the mentored students are making. I understand that the Leon County Schools’ Mentor Program authorizes and provides insurance for mentoring of students only during school hours, on school property. I understand that according to state law (Florida Statue 1002.22) I must protect the confidentiality of my student at all times except when: I feel he/she is showing signs of depression and possible suicide; He/she indicates a desire to do harm to another individual; I see/hear signs of possible neglect or abuse; I see/observe signs of drug abuse, or I see or a student reveals that they are seriously ill. In all of the examples above, the proper course of action to take is to notify school staff immediately, and in the case of suspected child abuse, neglect, or abandonment, I am expected to call the Florida Child Abuse Hotline (1-800-96-ABUSE). I understand that all mentor visits should be conducted in an open setting, where other adults can observe me. I understand that I should NOT bring food or gifts to my student without first discussing it with my school’s Mentor Coordinator first. I understand that I should NOT give a student any medication. I understand that Leon County Schools DOES NOT allow any physical punishment of students. I understand that when the mentor relationship ends, I should say “good-bye” to my student personally. I have read and understand the above guidelines.
Mentor Signature / Attestation
To confirm your understanding of the scope, policies and procedures for Leon County Schools Mentor Program, please sign your name below.
Mentor Applicant Signature (Type your full name here.)		Mentor Signature Date
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