SY2022-2023 CHS Volunteer Application Form
In Accordance with AR1240, the Matanuska-Susitna Borough School District reserves the right to run your name through the State of Alaska Sex Offender Database.  All volunteers must provide their legal name and aliases on this form and agree to be checked in the Sex Offender database, prior to beginning as an active volunteer, annually.  By signing below, I understand that all student information to which I have access as a school volunteer is confidential.  Such information might include health information in written, oral, or electronic form.  I agree not to discuss any confidential information, including but not limited to any descriptions of situations as well as names of students.  I also understand that even when I am no longer a volunteer for MSBSD, confidential information I have learned as a volunteer must continue to be kept confidential.
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First name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Aliases
Physical Address *
Mailing Address
Home Phone
Cell Phone
Have you ever received a protective order? *
If yes, explain
Have you ever been convicted of a misdemeanor? *
If yes, explain,including relevant dates.
Have you ever been convicted of a felony? *
If yes, explain, including relevant dates.
Area/Classroom you will be volunteering *
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