Community Volunteer Application  2019-2020
You agree to check-in at the front office and provide a valid Colorado Driver's License or ID prior to performing any/all volunteer commitments.

(District form REV 5/2016)
Please complete this Community Volunteer Agreement if you are:
1.  Not a parent or guardian of a current Renaissance student.
2.  A chaperone on an overnight Voyage or Field Work (ALL chaperones attending an overnight trip.)
3.  Teaching a before- or after-school Enrichment Class.

*SCHOOLS: SEND APPL. W/COPY OF COLORADO DRIVER’S LICENSE
FOR OVERNIGHT CHAPERONES: RISK MANAGEMENT - Debbie.Warren@dcsdk12.org 
FOR ALL OTHER NON-PARENTS: SECURITY - volunteer-backgroundsusergroup@dcsdk12.org
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Douglas County School District
1.  PERSONAL INFORMATION
First Name *
Middle Initial
Last Name *
Date of Birth *
MM
/
DD
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YYYY
Driver's License/State ID Number *
Street Address *
City *
State *
Zip Code *
Current Telephone Number *
Current Email Address *
2.PLACEMENT INFORMATION
Choose where you will be volunteering: *
Required
School Requested
Renaissance Expeditionary Magnet School
Contact Person at School
Janell Lewis
School Contact Email
janell.lewis@dcsdk12.org
3.  WORK EXPERIENCE
Current or Most Recent Position *
Organization *
Supervisor *
Work Phone Number *
Employment Dates (MM/YY - MM/YY) *
Specific Responsibilities *
Reason for leaving (if applicable)
4.  REFERENCES
Please list three people who you have known in a work and/or volunteer capacity or on a personal level:
Name *
Work/Home/Cell Phone *
Relationship *
Name *
Work/Home/Cell Phone *
Relationship *
Name *
Work/Home/Cell Phone *
Relationship *
5.  SCHOOL/CLASSROOM EXPERIENCE
For the best possible placement, please answer the following questions:
1.  What experience have you had working with children? *
2.  Do you have any special skills, qualifications or capabilities that would help us place you? *
3.  What type of volunteer work are you most interested in? *
6.  ADDITIONAL INFORMATION
*
Have you ever been convicted of, pled nolo contendere (no contest) to, or received a deferred sentence or deferred prosecution for a felony, a misdemeanor crime involving unlawful sexual behavior, or unlawful behavior involving children?
*
Have you ever been convicted of any other misdemeanor, other than a misdemeanor traffic offense or traffic infraction? (Conviction will not automatically disqualify you.)
If Yes to Either:
If your answer is “Yes” to either of the above questions, please provide the details, including a description of the felony or misdemeanor charge, the date of the disposition of the charge, and the court involved:
Please Read Carefully:
*
As a Community Volunteer assisting within the Douglas County School District Re. 1 (“District”), you have been authorized by the Principal or the Principal’s designee to act as a school official subject to the direction and control of the school’s administrators and teachers. You understand and agree that your failure to maintain the confidentiality of all student education records and information to which you are given access may disqualify you from further service as a community volunteer in the District.
Required
Background Check *
By providing the information requested and signing below, you consent to the District conducting a background check and understand that the District reserves the right to decline the volunteer service of anyone.
Required
*** PLEASE EMAIL A COPY OF YOUR VALID COLORADO DRIVER’S LICENSE TO JANELL LEWIS AT REMS ***
or
*** PLEASE PROVIDE A PHOTOCOPY OF YOUR VALID COLORADO DRIVER’S LICENSE TO THE FRONT OFFICE ***
ELECTRONIC SIGNATURE
By entering my initials below, I agree to the above terms and understand that I am providing an electronic signature which will serve as authorization and verification of the accuracy and completeness of the information I have provided.
I certify that I am 18 years of age or older. *
Applicant Initials *
My typed name above along with these initials represent my electronic signature
Date Signed *
MM
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