Volunteer Program Use Only

Data entered (date): ________________

Community and Entered by (name): __________________________

Schools Together (CAST) Guidelines accepted: ________________

an initiative of Dorchester County Public Schools

Volunteer Information Form

2017-2018

Thank you for your interest in becoming a champion for students and helping to support our
schools! For the protection of our pupils, it is necessary to perform a screening process. This
information will be held in confidence within DCPS.

PLEASE PRINT and provide all information requested. An incomplete or illegible form
delays the screening process. You must be at least 18 years old to complete this form. This form
must be received by your school at least 10 days before you wish to volunteer.

Section One

FULL LEGAL NAME of Volunteer Date of Birth

______________ ______________ ______________ __ __ __ __ __ __ __ __

Last First Middle Month Date Year

All previous names:

Home Address: _______________________ ________________ _____ _______

Street City State Zip Code

Email ______________________________ Primary Phone ______________________

Employer
 Section Two

Criminal History Statement

Have you ever pleaded guilty, been convicted, fined, imprisoned, or placed on
probation for the violation of ANY law? Do you have any Reopened/Active
court cases and/or are you currently awaiting disposition(s) from the court
system? (circle one) – if this page is incomplete your form will not be processed

*Yes No

*If your response is yes, please provide complete details below:

▪ violation(s)
▪ violation date(s)
▪ violation location(s) – state and county/region
▪ court disposition(s)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Dorchester County Public Schools reserves the right to reject any individual who willfully
misrepresents information on this form, including by omission.
A record of a conviction does not automatically exclude an applicant from consideration
to volunteer in Dorchester County Public Schools. Please note that some volunteer
positions will also require fingerprints to be taken for which there may be a charge.

My signature signifies that all information provided on this form is, to the best of my knowledge, true
and accurate.

______________________________________________ _________________
Signature Date

If you have any questions about this form, please contact Valerie Goff (goffv@dcpsmd.org or 410-
228-4747, x1008).

Volunteer Information Form Revised 07/27/17

Community and
Schools Together (CAST)
an initiative of Dorchester County Public Schools

Volunteer Information Form (Part 2)

2017-2018

NAME: ______________________________________________________________________

Phone no.: _____________________________ Email: _____________________________

Thank you for your interest in helping to support our schools! Please take note of the following:

• Volunteers need to complete only one form per school year. Each school maintains its own
list of approved volunteers. Please note on the next page the schools’ list(s) on which you
want to be included.
• You will be contacted ONLY if there is an issue with your form or you are not approved. If
you are unsure as to whether you have been approved, please ask the school or call 410-228-
4747 x1008.
• Volunteering in a Dorchester County school has a positive financial impact. Volunteer hours
help maintain grant funding, and volunteers are asked to be diligent about signing in and
out of their school in order to document every valuable hour of volunteer time.

The attached Standards of Practice for Volunteers describes behavior expected of volunteers. It is
important that all volunteers understand and adhere to these rules. If you have a question regarding
anything in the Standards of Practice for Volunteers, contact Valerie Goff, Community Involvement
Liaison, at goffv@dcpsmd.org or 410-228-4747 x1008 or ask the principal at your school. Please
indicate by your signature below that you have read, understand, and agree to abide by the Standards
of Practice for Volunteers. Failure to maintain these standards of practice may result in your services
as a volunteer in Dorchester County Public Schools being terminated. (If you have not received the
Volunteer Standards of Practice, please ask a school for a copy and do not complete and return
this form until you have received and read them. Your form will not be processed.)

I have read and understand the Standards of Practice for Volunteers

and agree to abide by them as a condition of volunteering in
Dorchester County Public Schools.

Signature

Name printed

Date
Highest level of education reached:

Some high school College graduate

High school graduate Graduate/professional school
Some college Technical school
Other (please specify)

Check all volunteer opportunities in which you are interested:

Field trip chaperone School activity chaperone/helper

Administrative help (media center,office) PTO activity helper
Character Counts Fundraising
Book Buddy Reading Team
Classroom helper/tutor (elementary) Tutor (middle or high school)
Other (please describe)

Each school maintains its own list of approved volunteers. Please check each school on whose list you
want to be listed and whether you are connected with a child in that school.

School List? Child? School List? Child?

CSD High School ND High School
Choptank Elementary ND Middle School
DCTC Sandy Hill Elementary
Hurlock Elementary South Dorchester K-8
The Judy Center Vienna Elementary
Maces Lane Middle School Warwick Elementary
Maple Elementary

If you indicated a connection with a child in the section above, please complete the following:

Child’s name (first and last) School Grade

Comments or additional information:

If you have any questions about this form or about becoming involved in a school, please contact
Valerie Goff (goffv@dcpsmd.org), 410-228-4747, x1008. Please return this completed form to the
school at which you will volunteer or directly to Valerie Goff, Dorchester County Public Schools, 700
Glasgow St., Cambridge MD 21613.
Thank you for your interest in Dorchester County Public Schools!

Revised 07/27/17
 Standards of Practice for Volunteers in Dorchester County Public Schools
(Please keep this sheet for reference)

1. All volunteers must sign in and out on the computer in the school office. As a safety measure, it
allows the school to know who is or who has been in the building. It also enables us to collect
and tabulate volunteer hours necessary for many grant applications.
2. Confidentiality is very important. Federal law (FERPA – the Federal Educational Rights and
Privacy Act) and state law require DCPS to protect the privacy of its students. While
volunteering you may observe, read or hear about individual students and their school or home
experience. Do not discuss anything regarding a student, including your observations or
opinions, with anyone other than the student’s teacher or school principal. All information
about student abilities, behavior, relationships, grades or background is confidential and only to
be discussed with the teacher or principal.
3. If a student shares any information with you that causes you concern for their safety or well-
being, tell the teacher or principal. They will follow up on the information appropriately. Keep
the content of the information and action you took strictly confidential.
4. To protect your privacy, and that of students, do not ask for a student’s address, phone number
or take their picture. Also, do not share your address or phone number with a student.
5. Student/volunteer interactions are limited to the school site. Volunteers are not allowed to
meet with students off of the school grounds, unless the student is accompanied by their
parent, or are connected to the volunteer through another agency (i.e. church, sports, etc.).
6. Let your conversation demonstrate respect for others and yourself. Avoid language that may be
perceived as discriminatory, sexist or offensive. You are a role model for students. Set a good
example in language and conduct.
7. Student discipline is always the responsibility of the school staff, not volunteers. Inappropriate
behavior should be brought to the attention of the teacher. DCPS practices positive discipline,
focusing on what we want children to do rather than what we do not want them to do.
Volunteers are encouraged to acknowledge appropriate behavior among students.
8. As a volunteer, you represent the school and DCPS not just ‘on the job’ but in the community.
Help spread the word about the good things that your school is doing. If you have concerns
about anything happening in the school, speak to the principal.

The Board of Education of Dorchester County

STATEMENT OF NONDISCRIMINATION

The Board of Education of Dorchester County does not discriminate in

admissions, access, treatment, or employment in its programs and
activities on the basis of race, color, age, sex, national origin, religion,
disability, sexual orientation or other basis prohibited by law.

Appropriate accommodations for individuals with disabilities will be

provided upon request. The information in this announcement is
available in alternative formats upon request.

Concerns regarding the above are directed to C. Dwayne Abt, Director

of Operations, Dorchester County Public Schools, 700 Glasgow Street,
Cambridge, Maryland, 21613, or by phone at 410-228-4747, extension
1015.