By checking each box and signing below, I confirm the following:

□ I acknowledge that I have received, reviewed and completed the Volunteer Packet

□ I acknowledge that I have received and reviewed the Student Code of Conduct and related policies.

□ I understand that volunteering at KSU requires compliance with all University policies, procedures, and applicable laws.

□ I understand that any volunteer under the age of 18 must have a Parent/Guardian Waiver submitted before participation.

□ I certify that the information provided on my Volunteer Application is true and complete to the best of my knowledge.

□ I understand that failure to follow University policies, procedures, or this agreement may result in dismissal from the volunteer program.

□ I acknowledge that I have a responsibility to maintain confidentiality regarding any University information, records, or activities accessed in my role.

By checking each box above and signing below, I certify that I have read, understood, and agree to the statements outlined in this form. I further acknowledge that I am responsible for upholding the standards, policies, and confidentiality requirements of Kentucky State University. I understand that failure to comply may result in immediate dismissal from the volunteer program and may limit my eligibility for future volunteer opportunities with the University.

Printed Name: ___

Signature: _____ Date: _____