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 - Legal First and Last Name Only
First Name	MI	Last Name
Birth Month (i.e. 09)	Birth Day (i.e. 05)	Birth Year (i.e. 1955)
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 of a felony related to violence? Yes No
Have you ever been convicted of a felony related to weapons charges? Yes No
Have you ever been convicted of a felony related to crimes against/involving children? Yes No
If you selected 'YES' to any of the above questions, please provide an explanation of the charges below, including 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 must always work under the supervision of a school staff member. Volunteers are required to follow staff directions in the event of a fire drill, lockdown, or emergency 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 proper course of action to take is to notify school staff immediately, and in the case of suspected child abuse, 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 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
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 850-487-7370.
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. Mentoring that occurs in a virtual setting will take place under the guidance, parameters, and direction of the school's mentor coordinator. All mentoring sessions (whether in-person or virtual) will take place during school hours and on school property. 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, I am expected to call the Florida Child Abuse Hotline (1-800-96-ABUSE). I understand that all mentor visits (whether in-person or virtual) should be conducted in an open setting, where school staff can observe me. Mentors and students cannot share e-mails, phone numbers, or personal addresses. No social media outlets interaction will be allowed such as Facebook, Twitter, Instagram, Snapchat, or similar platforms. 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.
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
Submit/Print Form
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