Community Service Form (Page 2 of 2) in pdf

Background Check Consent Form

On April 28th, 2008 the ANC Board of Directors approved the following procedures or screening all

those who are applying to volunteer with Allen Neighborhood Center.

1. All volunteer and staff (with the exception of Michigan State University students, who

are screened by MSU Service Learning Center) will be screened through the Michigan

State Police IChat System.

2. Confidential files are kept on all applicants and results.

3. When the I-Chat System reveals a criminal background, the Volunteer Program

Coordinator, in consultation with the Executive Director, will make a determination

whether this person’s offer of volunteer service will be accepted.

I understand and accept the terms listed above for participation as a volunteer at the Allen

Neighborhood Center.

___________________________________________________

Printed Name

___________________________________________________

Signature

____________________________

Date of Birth

__________________________________________________________________________________________________________________________________

Thank you for your interest in volunteering with the Allen Neighborhood Center! Once you have

completed this form, please submit it to Volunteer Coordinator, Kat Logan. You may do so by

scanning the document (front and back) and emailing it to ,

or submitting it in person/via the mail to the center. Once the documents have been submitted

the

severity of the reason for having to perform community service will be evaluated on a case by case basis, and

will be made in the best interest of the ANC staff and neighbors. Upon acceptance of the volunteer into the

ANC’s service program, a contract will be written specifying dates of service, number of hours, and details of

activities to be performed.

Allen Neighborhood Center

1611 E. Kalamazoo St. – Lansing, MI – 48912 – 517.999.3919

Community Service Form Page 2