Community Volunteer Application Form

Community Volunteer Application Form

Baxter Academy for Technology and Science
Our Baxter Academy of Technology and Science (BATS) community is made up of a robust network of people with various skill sets and areas of expertise. We hope to help our students gain access to the wealth of resources and knowledge in our community. Please let us know if you are able and willing to volunteer your time and lend us your expertise! Contact cicy.po@baxter-academy.org if you have any questions!
Full Name:*

First NameLast Name
Any Previous Last Names (leave blank if none):
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
If you have a student that attends Baxter, please indicate your student(s) full name and grade:
Please list the teacher or staff member you will be volunteering with:
Please list the type of activity you'd like to volunteer for (eg. classroom assistance, tutoring, special event, supporting a club/activity, servings as a Baxter Parent Liaison with our Head of School, helping with small tasks around the school, servings as a chaperone, serving as a family engagement volunteer)
Please list your areas of interest or expertise in a particular subject, topic, activity or program:
Industry Expertise - No industry work experience is too small! If you have industry expertise, would you consider:

Speaking to students in a class?Speaking to students during our Friday Speaker Series?Serving as a consultant with our school leaders or educators about areas of community need?Be available to an advisor or student for career or college exploration?Supporting a teacher in a discipline specific class?Photography for school events?
Multilingual Volunteers - Baxter is becoming an increasingly multilingual school both among faculty and staff as well as students. If you speak multiple languages, we would love to connect families with speakers of their languages.
What languages do you speak? Would you be interested in connecting with other members of the Baxter community who share your language(s)?

Background

The following information is asked of all individuals who work with our children to help ensure thesafety of our students.
Have you had any criminal conviction(s) within the past 2 years other than a minor traffic violation? *
Have you had any criminal conviction(s) within the past 10 years that involve(s) a minor? *
Have you had two or more criminal convictions within the past 10 years?*
Have you EVER had any assault or sexual misconduct convictions against a minor?*
If you have answered YES to any of the above questions, please provide details below.
Please upload a copy of your driver's license:

Cancelof
Signature*

Clear
Date*

MonthDayYear
Date

VOLUNTEER CONFIDENTIALITY AGREEMENT

I understand that ALL student and staff information is confidential. I agree not to access, review, disclose, or use confidential student or staff information without specific authorization from a school administrator. I also understand that even when I am no longer a volunteer in the schools, any confidential information I have learned must continue to be kept confidential. I understand that any breach of these confidentiality requirements will result in my immediate termination as a volunteer and may result in legal action against me. I understand that I must comply with all Board policies and school rules applicable to school staff, as well as all directions from school administrators and staff while serving as a volunteer. I further understand that my authorization to serve as a volunteer may be terminated at the discretion of the Executive Director and Head of School at any time if they determine it is in the best interests of Baxter Academy for Technology and Science.
I, First Name* Last Name* authorize Baxter Academy for Technology and Science to perform a criminal background check. I have been fully transparent and truthful in the information and responses to all the questions on this application. I understand that as a volunteer applicant, I am required to sign the Volunteer Confidentiality Agreement. I am aware that I will receive no compensation for my services.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Community Volunteer Application Form

Background