Volunteer Assessment Form printable pdf download

VOLUNTEER ASSESSMENT FORM

Team Sport:____________________________________

Date:

Name:

Last

First

Middle Initial

Other (Nickname, Surname, Maiden Name, etc.)

□

Race:

Date of Birth:

Male

Female

□

Month

Day

Year

Caucasian

□

Address:

African American

Street Address

□

Asian or Pacific Islander

□

City

State

Zip

American Indian or Alaskan Native

□

Phone:

Hispanic

□

Unknown/Other___________________

Children attending Grand Haven Area Public Schools? ___ YES ___ NO

Child’s Name

Building Attending

Relationship

If you answered NO to the above question, what is your affiliation/reason for volunteering in the building?

Michigan Driver’s License #

I understand that it is necessary to have a Michigan State Police background check done before I volunteer in Grand Haven

Area Public Schools. I understand that the information submitted will remain confidential. I agree to allow district-designated

personnel from Grand Haven Area Public Schools to submit the above information to the Michigan State Police ICHAT

(Internet Criminal History Access Tool) for review.

Signature of Volunteer

~ FOR OFFICE ONLY ~

School Submitting Check:

MAW

ROB

ROSY

LSMS

WPMS

GHHS

CENTRAL HS

ESC

Date Check Completed:_______________________________________________________________

Results of Check:

If YES (record found), what is final disposition/comments: ____________________________________

___________________________________________________________________________________

Information Submitted by:______________________________________________________________

Grand Haven Area Public Schools do not discriminate on the basis of race, color, religion, sex, national origin, age, height, weight, marital status, handicap, disability,

or limited English proficiency in any of its programs or activities. The following office is designated to handle inquiries regarding the nondiscrimination policies:

Assistant Superintendent of Human Services, Grand Haven Area Public Schools, 1415 Beechtree Street, Grand Haven, MI 49417 616.850.5085

Copy Center District Forms 7-04/Revised 5-08 (VOLUNTEER ASSESSMENT FORM)