By answering and entering your name and other information below, you affirm that the information is true and complete to your knowledge. By providing direct services to children, you authorize the Evansville Vanderburgh School Corporation to conduct a criminal record check, which will be contingent upon your placement and or continuation with all programs.
The Evansville Vanderburgh School Corporation does not discriminate on the basis of sex, color, religion, national origin, age or disability in any of its educational or employment programs or activities.
If you have questions about this form, please contact Kathy Osburn at the EVSC's Center for Family, School, and Community Partnerships at 812-435-8378.
First Name: Middle Name: Maiden Name:
Address: City: State: Zip:
Phone: Cell Phone: Email:
List the name(s) of the school or schools at which you want to volunteer:
Are you volunteering as a: SelectParentCommunity MemberFamily MemberCollege Student
Please select areas of interest (hit control to select multiple areas): Assist Nurse Office Help Classroom Help Backpack Program Field Trips Area Council PTA Clothing Bank Library/Book Fair Parent Teacher Association (PTA & PTSA) Tutor Mentor Coaching Sports Team Other:
If you wish to volunteer at an event or field trip, please list the date of the event (mm/dd/yyyy):
Name of organization through which you are volunteering:
Have you ever been convicted, pled guilty or pled no contest to a criminal offense, other than a minor traffic violation? Yes No
Have you ever been arrested for a drug or sexual related offense or act of violence? Yes No
Have you ever been convicted of a felony or charged with an offense involving drugs or alcohol? Yes No
Have you ever been convicted of a felony or charged with an offense involving child abuse, sexual aberrations or moral turpitude? Yes No
By select yes, I give my approval for the EVSC to conduct a criminal record check: Yes No