MMLA Volunteer Form
Thank you for your interest in volunteering. Keeping our students and staff safe is a top priority.  In order to ensure this safety, and in accordance with the Michigan School Safety Legislation and the National Child Protection Act, Mid-Michigan Leadership Academy requires a criminal record check be performed through the Michigan State Police ICHAT System on all volunteers who accompany and supervise students on field trips or who directly volunteer to work with students on a regular and continuous basis.  A valid Michigan driver's license or valid State of Michigan ID is required to conduct a Michigan background check. Background checks must be conducted for each school year you wish to volunteer.

Mid-Michigan Leadership Academy reserves the right to “approve” or “deny” any volunteer service upon review of the background check returned through ICHAT. The determination will be based upon the individual’s fitness to have responsibility for the safety and wellbeing of children. Providing false information, or information contradicting the background check information, is grounds for immediate volunteer denial.

Completing this form provides your consent for Mid-Michigan Public Schools to conduct a background check through the Michigan State Police Internet Criminal History Access Tool (ICHAT) system.  
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Email Address *
Volunteer Name / Previous Names
First Name *
Middle Name *
Please provide your FULL middle name not just an initial. NA if you do not have a middle name.
Last Name *
Suffix
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Maiden Name / Previous Name *
Type NA if not applicable
Demographic Information
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Race *
Gender *
Street Address *
Example: 123 Street Dr
City *
State *
Zip Code *
Phone Number *
Include Area Code. Do not use spaces or dashes. Example 1234567890
Disclosures
Have you been convicted of, or pled guilty or nolo contenders (no contest) to any crimes (misdemeanor or felony)? If you choose "I have been" please list those items you have been convicted of or pled guilty to below. *
List all crimes (misdemeanor or felony) you have been convicted of, pled guilty or nolo contenders (no contest) to.
How did you hear about volunteering at MMLA?
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MMLA's Commitment to Student Safety
Mid-Michigan Leadership Academy reserves the right to approve or deny any volunteer service upon review of the background check returned through ICHAT. The determination will be based upon the individual’s fitness to have responsibility for the safety and well-being of children. Providing false information, or information contradicting the background check information, is grounds for immediate volunteer denial.
Digital Signature *
Checking the box below represents your acknowledgment the information above is correct and your acceptance of this volunteer registration form.
Required
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