Student Leadership Council Application

Student Leadership Council Application

Ronald McDonald House Charities of Northwest Florida
Welcome to the online Student Leadership Council Application and Background Check Disclousre for Ronald McDonald House Charities of Northwest Florida. We apprecitate you taking the time to carefully fill out each field on this form.

Upon completion of the online application, please submit one letter of recommendation to the Student Leadership Advisors at slc@rmhc-nwfl.org.

If you have any questions or problems completing the application, please contact Kathryn Coaker, Database Strategy Manager, at 850.477.2273 or by email at kathryn@rmhc-nwfl.org.
Our Mission

The mission of Ronald McDonald House Charities of Northwest Florida is to love and support families of children with medical needs by giving them a place to call home.
Our Philosophy

Our philosophy is simple — nothing else should matter when a family is focused on healing their child — not where they can afford to stay, where they will get their next meal or where they will lay their head at night to rest. That's why Ronald McDonald House Charities of Northwest Florida strives to be the best home-away-from-home for families who travel to Pensacola to receive critical medical treatment for their children. Since opening in 1984 with a six-bedroom House and growing to our current 26-bedroom facility in 2010, then opening our new Family Room inside Studer Family Children's Hospital, we have served over 26,000 families.

Applicant Information
Today's Date:

MonthDayYear
Date
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Name of High School*
Please specify if you are a rising junior or senior.*
Person to Notify in Case of Emergency:
Full Name:*
Street Address:*
City, State, Zip:*
Relationship to Volunteer:*
Phone Number*

Application Questions
Please list and explain your personal interests, talents and hobbies. Please also elaborate on any organizations, clubs, sports or other other commitments in which you are involved.*
What previous leadership positions have you held, and how do you plan on integrating them into the Student Leadership Council?*
Explain how you work effectively as an individual and as part of a team.*
What attracted you to become a member of the Student Leadership Council? In what ways can the Student Leadership Council benefit you? Explain in detail.*
What ideas do you have that could be incorporated for upcoming fundraising opportunities?*
What is your current GPA on a 4.0 scale?*
In 300 words or less, explain what volunteerism means to you.*

Criminal History Background Check Authorization
Criminal History - Have you ever plead guilty to or have you ever been convicted of a crime identified as a misdemeanor or felony, including but not limited to traffic violations?*
If yes, please explain.
Required Hours - If you are completing volunteer hours for a class, program, court-mandated hours, or other program please indicate below or select NOT APPLICABLE.

Hours neededNot applicable
Program/Class/Other:
Required Number of Hours:
Contact Person's Phone Number:
Required Due Date:

Volunteer Agreement
Agreement and Signature

I affirm the information provided on this application is true and complete. I agree to conform to all policies and regulations as stated by Ronald McDonald House Charities of Northwest Florida. I understand by signing this form I am giving permission for a security check including, but not limited to, a criminal background check with any State agency, Federal agency, or any other appropriate agency. I understand this application does not guarantee a volunteer placement. I understand if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my privilege to volunteer being revoked.
Electronic Signature*

First NameLast Name
Date:*

MonthDayYear
Date
Volunteer Agreement

Thank you for choosing the Ronald McDonald House of Northwest Florida to donate your most valuable asset: your time. Please know RMH staff could not do their jobs without ALL our volunteers. Thank you again for choosing our Home as your charity of choice. The purpose of this agreement is to ensure all RMH volunteers are aware of what will be asked of them.

As a Volunteer I agree:
- To read the Volunteer Handbook.
- To fulfill assigned volunteer commitment of at least 2 hours or more unless otherwise approved by Volunteer Services Coordinator. (Having dependable volunteers for each shift is crucial to the daily operation of the House.)
- To notify the Volunteer Services Coordinator at least 24 hours before I am unable to work my scheduled shift.
- To reschedule my service time if I have or have been exposed to a communicable disease.
- To notify the Volunteer Services Coordinator at least 2 weeks prior to separation from RMH.
- To be courteous and professional. (Volunteers represent RMH to our families and the public. If you have a problem or concern, be sure to discuss it with the Volunteer Services Coordinator)
- To respect the privacy of each visitor/donor/family by keeping their information (personal & business) confidential.
- To ensure the safety and well-being of children and to maintain the integrity of RMH and its volunteers, I will not take responsibility for supervising children in the absence of their parent/guardian.
- RMH families and guests are never to be transported in personal vehicles and I will not open my home to RMH guests or families as a place to stay.
- To seek the assistance of staff on duty in any situation requiring special guidance.
- To refer all media inquiries to the Development Director for comments.
- To withhold personal medication from family members, staff or other volunteers.
Volunteer Conflict of Interest Disclosure and Confidentiality Statement

During the time I serve as a volunteer of Ronald McDonald House Charities of Northwest Florida, I realize I will gain access to information that is considered to be confidential and/or proprietary. Such information relates to families, donors, strategic planning and initiatives, submitted proposals, criteria or decisions made with regard to the business of Ronald McDonald House Charities of Northwest Florida.

Since confidential and proprietary information is crucial to the operation of the Organization, and because RMH in some instances has the obligation to protect such information, I agree I will not use, publish or disclose such information during or subsequent to my time volunteering, and I will preserve the restricted nature of this information except to the extent it becomes publicly available, or is otherwise lawfully obtained outside the scope of this agreement from third parties.

Additionally, as a volunteer, I realize I have an obligation to disclose and eliminate (if necessary) any potential or actual duality of interest or conflict of interest.

Below, I have listed all community organizations, non-profit corporations or charitable programs I, or a member of my immediate family have a relationship with, have sought or may in the future seek to do business with RMHC/NWFL. The term “relationship” means any relation with a person or organization, whether financial (such as a significant donation of more than $100), employment (such as a volunteer assignment, part-time job or as a consultant or independent contractor), or fiduciary (such as a board member or officer). The term “immediate family” means spouse, parent, children or other individual living in the same household.
I hereby certify I have read, understand and agree to the Foundation’s policies as described in this statement, with respect to confidential information and conflict of interest, and the information given in this statement is complete and accurate to the best of my knowledge.
Date*

MonthDayYear
Date
Electronic Signature*

First NameLast Name
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Student Leadership Council Application

Our Mission

Our Philosophy

Applicant Information

Application Questions

Criminal History Background Check Authorization

Volunteer Agreement