VOLUNTEER AGREEMENT AND RELEASE

SECTION I: GENERAL INFORMATION

Kentucky State University (KSU) requires individuals serving as volunteers to complete all applicable screening and approval requirements before beginning volunteer activities. The information provided in this agreement will be used solely to evaluate, approve, and document the individual's volunteer service in accordance with University policy and applicable state and federal laws.

Completion and approval of this agreement are required before an individual may begin providing volunteer services to Kentucky State University. Completion of this form does not create an employment relationship or guarantee approval of the volunteer assignment.

SECTION II: VOLUNTEER INFORMATION

(First Name)Middle Name (Required; Enter N/A if None)Last Name
Department/Program:
Volunteer Position/Role:Supervisor:
Service Start Date:End Date:
Description of Volunteer Services:
First Name
Middle Name
Last Name
Department/Program
Volunteer Position/Role
Supervisor
Service Start Date
End Date
Description of Volunteer Services [1]
Description of Volunteer Services [2]
Description of Volunteer Services [3]
Description of Volunteer Services [4]

SECTION II: VOLUNTEER RESPONSIBILITIES AND ACCESS

  1. 1. Will the volunteer have direct contact with minors? ☐ Yes ☐ No
1. Will the volunteer have direct contact with minors
1. Will the volunteer have direct contact with minors
  1. 2. Will the volunteer drive a vehicle on University business? ☐ Yes ☐ No
2. Will the volunteer drive a vehicle on University business
2. Will the volunteer drive a vehicle on University business
  1. 3. Will the volunteer have access to confidential records or information? ☐ Yes ☐ No
3. Will the volunteer have access to confidential records or information
3. Will the volunteer have access to confidential records or information

If yes, please explain:

___

If yes, please explain [1]
If yes, please explain [2]
If yes, please explain [3]

Supervisor Initials: ___

Supervisor Initials