Volunteer Application
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5IICC SP Exhibit A
North Clackamas School District
q CRIS OK
Volunteer Application Form
q OTHER
Name ____________________________________________
School ____________________________________________
Address __________________________________________
Parent q Non-parent qDo you have children? Yes __ No ___
City __________________ State _____ Zip _____________
If so, how many? _______
What ages? _____________
E-mail __________________________________________
Student(s) Name(s)__________________________________
Home Phone
___________________________________
Relationship to student_______________________________
Cell Phone
__________________________________
Other names/Maiden Name____________________________
Work Phone
___________________________________
Birth date ________________________
Employer ________________________________________
Preferred Grade Level
K-6 q
7-8 q
9-12 q
Occupation _______________________________________
Medical info in case of emergency ______________________
I waive and will not bring any claim against NCSD, including negligent acts of district agents, for damage to my personal property or
any injury to myself as a result of my volunteer activity. I agree to this action to the fullest extent allowed by law. Applicants that fail
to complete information, provide misrepresentations or untrue facts will be denied the opportunity to volunteer. Per NCSD policy/stan-
dard practice, in an effort to maintain a safe environment, a criminal history verification is required for some volunteer activities.
Applicant’s Signature_______________________________________
Date__________________________
Check all preferred volunteer areas below:
q Classroom
q Lunch supervision
q Job shadow host
q Reading
q Lunch Buddy
q Guest speaker
q Start Making A Reader Today (SMART)
q ASPIRE mentor for H.S. students
q Informational interview
q Math
q Library
q Mock interview
q Science
q Child care during parenting classes
q Worksite visit/tour
q Drama
q The Parent Institute
q Classroom project advisor
q Art
q Backpack Buddies
q Career fair at the school
q Coaching
q Clerical/office help
q Junior Achievement presenter
q Foreign language: _____________________
q Summer Food Program
q Mentorship
q Instrumental music
q Field trip driver/Chaperone
q Student internship
q Vocal music
q Wichita Community Center
q School enterprise advisor
q Student attendance
q Wichita Family Support Center
q Service learning
q College/career center
q Other ______________________________________________
Work/volunteer experience relating to areas of volunteer interest: _______________________________________________________
What days and times can you volunteer? __________________________________________________________________________
Can you volunteer
Weekly _________
Monthly ___________
Occasionally ___________
How did you hear about the volunteer program?
q Local school
q Web site
q Brochure
q Mailing
q Presentation
q Poster
q From a parent
q Student
q Newspaper
q Cable channel 28 (27 in Happy Valley) q From a teacher
q Business
q Radio/TV
q Service club
q Newsletter
q Church/place of worship
q From a friend
q Other ___________________________
If you know where you wish to volunteer, submit the form to that location.
If not, please mail to: Volunteer Coordinator, 4444 SE Lake Road Milwaukie, OR 97222
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