The School Board of Gadsden County - PC\|MAC

THE SCHOOL BOARD OF GADSDEN COUNTY

"Putting Children First"

35 Martin Luther King, Jr. Blvd Quincy, Florida 32351

Main: (850) 627-9651 or Fax: (850) 627-2760 gcps.k12.fl.us

Roger P. Milton

Superintendent

miltonr@

2017-2018 Volunteer/Mentor Application

Name: ____________________________________________________________________________________________________________

Last

First

MI

Address: __________________________________________________________________________________________________________

City

State

Zip

E-Mail Address:___________________@___________________________

Gender: _______ Male ______Female

Phone: ___________________________________________________________________________________________________________

Home

Work

Cell

Date of Birth: _____________________________________ Driver License #__________________________________________________

Highest Level of Education: High School

Circle One

College

Other_____________________________________________

Special Skills: (bilingual, computer, etc...) ________________________________________________________________________________

Note: A High School Diploma or its equivalent is preferred when providing tutoring services Please include a copy of your driver's license with application

Preferences: Please circle your interest

Volunteer

Office Assistant

Chaperone

Bus/Lunchroom Monitor

Classroom Assistant

Mentor

School(s) ___________________________________________________________________________________________________________

Have you ever been convicted of any crime involving or against a minor?

YES

NO

Have you ever plead guilty to, been convicted of or involved with any other type of crime?

YES

NO

Important Volunteer/Mentor Policies and Guidelines All Volunteers must complete a new Volunteer/Mentor Application each year for background screening. A Volunteer must sign-in at the front office before proceeding to their assignment. Volunteers may not dispense medications or administer any form of punishment to students. Volunteers must respect a student's right to confidentially. A Sexual Offender & Predator Check must be processed on all school volunteers/mentors.

I hereby authorize the Gadsden County School District to check any and all records pertaining to criminal convictions, and for any law enforcement agency to release information regarding convictions under Florida statutes or statutes of other jurisdiction.

Signature________________________________________________________

Date: ____________________________

(DISTRICT USE ONLY) Screener: _____________________________________Status: _________Cleared

________Flagged Date: ____________________

Audrey Lewis

DISTRICT NO. 1 HAVANA, FL 32333 MIDWAY, FL 32343

Steve Scott

DISTRICT NO. 2 QUINCY, FL 32351 HAVANA, FL 32333

Isaac Simmons, Jr.

DISTRICT NO. 3 CHATTAHOOCHEE, FL 32324

GREENSBORO, FL 32330

Charlie D. Frost

DISTRICT NO. 4 GRETNA, FL 32332 QUINCY, FL 32352

Tyrone D. Smith

DISTRICT NO. 5 QUINCY, FL 32351

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