SDFA Volunteer Application Form
Volunteer assistance to the School District of Fort Atkinson is recognized as an important component of district operations.  In an ongoing effort to ensure the safety of our students, staff, and visitors, the School District of Fort Atkinson requires all volunteers to complete a volunteer form annually.  If you have any questions or concerns regarding this form or the approval process, please contact the School District of Fort Atkinson Human Resources Office at 920-563-7801 or at hr@fortschools.org.

Please note, a MINIMUM of 48 hours is required for an application to be processed by school district personnel.  If you wish to confirm that you are an approved volunteer, please contact your school's office.

All adults who wish to volunteer in the schools for educational purposes and at school-sponsored activities are subject to a Wisconsin criminal background check, which includes a criminal record check for conviction(s) and pending charges through the Wisconsin Department of Justice Online Record Check System and the National Sex Offender Registry.

Volunteer background checks must be completed annually.  Individuals will not be allowed to volunteer or chaperone until a criminal background check has been conducted.
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E-mail *
**********Please Read the Following Information Carefully **********
Today's Date *
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LEGAL First Name *
(ex. Robert vs. Bob, Kathleen vs. Kathy, etc.)
LEGAL Middle Name *
LEGAL Last Name *
Maiden Name or Other Name(s) Used - enter N/A if none *
Date of Birth *
MM
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DD
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YYYY
Race *
Gender *
Street Address *
City / State / Zip Code *
Phone Number *
Please include area code and use format: XXX-XXX-XXXX
Social Security Number
Who should we contact if there is an emergency? (Name, Phone Number) *
List your students that are in the district. *
Have you had a background check conducted by the District in the past? *
Activities/Employee(s) you would like to volunteer for: *
School(s) you would like to volunteer at (select all that apply): *
Required
Question 1:  Are you a registered sex offender? *
Question 2:  Have you ever, in your lifetime, been convicted of (or pled no contest to) or have any charges pending for felonies, misdemeanors, and/or ordinance violations other than minor traffic violations?  (**This includes any court addressed charges for battery, disorderly conduct, worthless checks, etc.**) *
If you answered yes to Questions 1 and/or 2, please complete the following: *
Please explain: include date, location, nature, and circumstance of offense.  A record of arrest or conviction may not exclude you from volunteering in our school district, but a failure to disclose or misrepresentation in this statement will exclude you.
Acknowledgement

I, as a volunteer for the School District of Fort Atkinson, fully understand that this position is strictly on a volunteer basis and therefore entitles me to no pay or wages from the School District of Fort Atkinson.  I further understand that I am to follow the rules of behavior that are expected of the School District of Fort Atkinson staff and other rules as they pertain to my duties.  I do understand that my service to the District and my presence in the District as a volunteer is at the pleasure and direction of the District.  I understand that I am not an employee of the District and I am not eligible for any employment-related benefits, including, but not limited to, worker's compensation insurance.  I understand that I must be familiar with and that I must comply with all Board Policies while serving as a volunteer in the District.
Refer to: Board Policy 8120 - Volunteers

I authorize the School District of Fort Atkinson to review my personal background at the District's expense.  I consent to having the District conduct a full and complete background check.  I understand that any misrepresentation, or material omission of relevant facts on this form my result in immediate disqualification for any volunteer service within the School District of Fort Atkinson.  I understand the School District of Fort Atkinson will verify the information I have provided on this form.  I hereby release the District, its Board and its agents, as well as providers of information from any liability related to or arising out of furnishing and receiving information related to my background.

I understand that all personal and/or educational information regarding district employees, families, parents, staff, and/or students, which is revealed to a volunteer in the course of his/her service to the District must be regarded as confidential.  This includes a student's academic, attendance, disciplinary, health, and medical records; contact information and telephone number; and all other student information.  Any information about district employees, families, parents, staff, or students acquired while volunteering must NEVER be communicated beyond the scope of District personnel who require such information to work with the student.  Any violation of this confidentiality shall be considered a gross violation of district rules and may lead to immediate exclusion from volunteering with the School District of Fort Atkinson.

Electronic Signature - I have read the above acknowledgement and understand that my electronic signature constitutes my legal permission for the School District of Fort Atkinson to process my background check. *
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