Volunteer Application
-

Leon School Volunteer Program

Bloxham Building
725 South Calhoun Street, Tallahassee, FL 32301
Phone: (850) 487-7800 • FAX: (850) 487-0443
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 and must be renewed each year.

Fields marked with a red * are required.

Volunteer Interests






Volunteer Individual












Mailing Address










Contact Information






(Important School Communication Tool)

Emergency Contact Information




Affiliations & Other Information

Yes No



Yes No



Yes No



Yes No


Security / Background

Yes No

Yes No

Yes No


IMPORTANT VOLUNTEER POLICIES AND GUIDELINES
  1. All volunteers must sign in at the school office before proceeding to their volunteer assignment.
  2. Volunteers may not dispense any medications (prescription or over-the-counter) to students.
  3. Volunteers may not administer any form of corporal (physical) punishment to students.
  4. 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.
  5. School Board Policy 2430.01 - Volunteer Program, requires that a National Sexual Offender/Predator Check be processed on all school volunteers.

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.







Mentor Information

Yes No


Yes No


Yes No











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, 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.
Mentor Signature / Attestation
To confirm your understanding of the scope, policies and procedures for Leon County Schools Mentor Program, please sign your name below.





Submit/Print Form

You must still submit this form after printing it.
Printing the form is optional!

Hit Submit, if "Thank You" message does NOT appear, go back to top and complete fields that are shown in RED.