Contact Information

Todays Date

YYYY

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Contact Number

(###)

###

####

Date of Birth

YYYY

Gender

Male

Female

Mobility Needs: Identify accommodations required

Foreign Language Kills (other than english)

Language

Write Fluently

Speak Fluently

Language

Write Fluently

Speak Fluently

Areas of Interest (check all that apply)

We offer a general volunteer orientation to introduce the organization, our programs and other volunteer opportunities. If you are unsure of your interest, we can register you for an orientation, then proceed.

Programs:

*Read Aloud Programs – flagship read-aloud program for preschool-3rd grade students, 9-month commitment Check preferred age group

*preschool

*ages 3-5

*K-3rd, ages 5-9

Adolescent Book Group – flagship book group-style program for high school students, 9-month commitment

Scholarship Program – scholarship & mentor program for high school students pursuing further education, 1-year commitment

Scholarship Selection Panel – selecting and awarding scholarship applicants, 2-month commitment

Family Literacy Program – parent education workshop series, 10-week commitment

Committees

*If checked, will contact you separately regarding more specifics

PR & Communication

Event

Finance Fundraising

Development*

Program*

Time Available (check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Weekend

Morning (8am-12pm)

Afternoon (12pm-4pm)

Evening* (4pm-8pm); Does not pertain to classroom programs.

Commitment Clause

Words Alive is a volunteer driven organization that thrives from your support. Therefore, your commitment is essential to our mission and our success in the classroom and the community. Once placed in one of our committees, programs, or as an outreach or office volunteer (a volunteer of any capacity) it is your duty to fulfill your role and participate when scheduled. If unable to participate on scheduled day, please notify your Program Manager (or a Words Alive staff member) so that we mayfind a substitute reader or reschedule. In the interest of maintaining continuity in the classroom, missing 25% of scheduled sessions without due notice during the program year will result in a review of your role as a Words Alive volunteer. Words Alive has an open door policy and we welcome any feedback, questions and concerns at any time. Your volunteer experience is important to us, therefore we have created an environment that enables success for our volunteers and program participants. Please let us know if you have suggestions for improvement.

I have the ability to commit.

BACKGROUND INFORMATION

Education

High School

College

Graduate School

Currently employed?

Yes

Occupation:

Position/Title:

Employer:

If no, reason

Previous volunteer experience?

Yes

If yes, name of organization(s):

Volunteer jobs performed:

Have you volunteered with Words Alive before?

Yes

If yes, what was your role within Words Alive?

In what other organizations or causes are you interested and/or involved with?

How did you hear about volunteer opportunities at Words Alive?

Community Event

Friend/Relative

Internet

Newspaper

Volunteer Agency

Other:

Why do you want to volunteer?

*Please note, we do not provide volunteer opportunities in exchange for court ordered hours.

To Serve

School

Credit

Court Ordered*

Other:

EMERGENCY CONTACT INFORMATION

Name

First Name

Last Name

Relation

Contact Number

(###)

###

####

Have you been ever been convicted of any offenses, including misdemeanors or felonies (excluding minor traffic offenses)?

Yes

If yes, please explain (date, violation, reason):

If volunteering within the classroom through one of our programs, Words Alive requires a background check to verify volunteer records.

VOLUNTEER POLICIES PLEASE REVIEW, SIGN THE SIGNATURE PAGE AND RETURN TO WORDS ALIVE

CODE OF CONDUCT Words Alive is a non-profit charitable organization dedicated to promoting literacy and reading for fun in children, teens, and adults. Words Alive has traditionally demanded and received the highest ethical performance from its employees and volunteers. In an effort to maintain our high standards and enable the organization to continue to offer its services, Words Alive operates under the Code of Conduct outlined below. All employees and volunteers are required to sign the Code of Conduct form, certifying that in delivering Words Alive services and in all other Words Alive activities, they shall meet the following standards of conduct Compliance Requirements. All employees and volunteers are required to comply with applicable federal, state and local laws and regulations and with Words Alive policies and regulations. Actions Prohibited by the Code of Business Ethics and Conduct. No employee or volunteer shall engage in the following actions: a. Personal Use. Authorize the use of or use for the benefit or advantage of any person, the name, emblem, endorsement, services or property of Words Alive, except in conformance with Words Alive policy. b. Financial Advantage. Accept or seek on behalf of or any other person, any financial advantage or gain of other than nominal value offered as a result of the employee’s or volunteer’s affiliation with Words Alive. c. Words Alive Affiliation. Publicly use any Words Alive affiliation in connection with the promotion of partisan politics, religious matters or positions on any issue not in conformity with the official position of Words Alive. d. Confidentiality. Disclose any confidential Words Alive information that is available solely as a result of the employee’s or volunteer's affiliation with Words Alive to any person not authorized to receive such information, or use to the disadvantage of Words Alive any such confidential information, without the express authorization of Words Alive. e. Improper Influence. Knowingly take any action or make any statement intended to influence the conduct of Words Alive in such a way as to confer any financial benefit on any person, corporation or entity in which the individual has a significant interest or affiliation. f. Conflict of Interest. Operate or act in a manner that creates a conflict or appears to create a conflict with the interests of Words Alive and any organization in which the individual has a personal, business or financial interest. g. Retaliation: Retaliate against any employee or volunteer who seeks advice from, raises a concern with or makes a complaint about fraud, waste, abuse, policy violations, discrimination, illegal conduct, unethical conduct, unsafe conduct or any other misconduct by the organization or volunteers. h. Contrary to the Best Interest of Words Alive. Operate or act in any manner that is contrary to the best interest of Words Alive.

CONFIDENTIAL INFORMATION AND INTELLECTUAL PROPERTY

Words Alive has sole entitlement to any intellectual property that is conceived or developed by volunteers and employees during the course of service to Words Alive. All registered volunteers and employees are required to sign a Confidential Information and Intellectual Property Agreement as a condition of volunteer service. Intellectual property includes inventions, discoveries, and original works of authorship as defined by US patent, trademark, and copyright law. This Confidential Information and Intellectual Property Agreement (“Agreement”) is made as of the date of signature (“Effective Date”), by and between Words Alive and the undersigned (“I,” “me” or “my”). Reasons for Agreement I desire to volunteer or to continue to volunteer with Words Alive. I acknowledge that I may, in the course of my service to Words Alive (“Volunteer Service”), have access to or create (alone or with others) confidential and/or proprietary information and intellectual property that is of value to Words Alive. I understand that this makes my position one of trust and confidence. I understand Words Alive needs to limit disclosure and use of confidential and/or proprietary information and intellectual property. I understand that all restrictions are for the purpose of enabling Words Alive to fulfill its humanitarian mission, to maintain donors and participants, to develop and maintain new or unique products and processes, to protect the integrity and future of Words Alive and to protect the employment and volunteer opportunities of Words Alive. THEREFORE, I agree to the following: 1. Definitions. “Confidential Information” shall include but not be limited to: (i) information relating to Words Alive financial, regulatory, personnel or operational matters, (ii) information relating to Words Alive participants, beneficiaries, suppliers, donors, employees, volunteers, sponsors or business associates and partners, (iii) trade secrets, know-how, inventions, discoveries, techniques, processes, methods, formulae, ideas, technical data and specifications, testing methods, research and development activities, computer programs and designs, (iv) contracts, product plans, sales and marketing plans, business plans and (v) all information not generally known outside of Words Alive regarding Words Alive and its business, regardless of whether such information is in written, oral, electronic, digital or other form and regardless of whether the information originates from Words Alive or Words Alive agents. “Intellectual Property” shall include but not be limited to: (i) all inventions, discoveries, techniques, processes, methods, formulae, ideas, technical data and specifications, testing methods, research and development activities, computer programs and designs (including improvements and enhancements and regardless of patentability), (ii) trade secrets and know-how, (iii) all copyrightable material that is conceived, developed, or made by me, alone or with others, (iv) trademarks and service marks and (v) all other intellectual property. 2. Obligation of Confidentiality. Except as may be required for the performance of my duties during my volunteer service, or unless specifically authorized in writing by Words Alive, I shall not use or disclose, for my or for others’ benefit, either during or after my volunteer service, any Confidential Information. 4. Ownership and Return of Material. All materials, including but not limited to business information, files, research, records, memoranda, books, lists, computer disks, hardware, software, cell phones and other wireless devices, documents, drawings, models, apparatus, sketches, designs and any other embodiment of Confidential Information or Intellectual Property received by me during my volunteer service, and any tangible embodiments of such materials created by me, alone or with others, whether confidential or not, are the property of Words Alive. I shall return to Words Alive all such materials, including copies thereof, in my possession or under my control upon termination of Volunteer Service for whatever reason or upon the request of Words Alive. The return of such materials shall take place within twenty-four (24) hours of notice of termination or upon request of Words Alive, whichever comes first.

HARASSMENT-FREE WORKPLACE

Words Alive is committed to a work environment free from unlawful harassment in which everyone is treated with respect and dignity while working, while on Words Alive premises, while traveling on Words Alive business, or at Words Alive social functions. Words Alive has zero tolerance for unlawful harassment. Unlawful harassment is defined as harassment based on any characteristic protected by applicable federal, state or local law including race, religion, color, sex, national origin, age, veteran or disability status, which is sufficiently severe or pervasive as to alter the working conditions of a volunteer or employee. Examples of conduct prohibited by this policy include, but are not limited to: 1. Verbal or physical conduct that harasses a volunteer on the basis of a category protected by applicable federal, state or local law and that is sufficiently severe or pervasive as to create an intimidating, threatening, offensive or hostile environment. 2. Sexual displays or publications, or other verbal or physical conduct, where a volunteer is told either explicitly or implicitly that he or she must submit to the conduct to remain involved as a volunteer or where his or her reaction to the conduct is used as a basis for a management decision, such as evaluation, advancement, assigned duties, disciplinary action, or any other condition of volunteer involvement or career development. Examples of prohibited verbal or physical conduct include-  Unwelcome sexual advances;  Stalking, dating violence, date rape or sexual assault;  Persisting with romantic advances despite the rejection of the advances;  Requests for sexual favors, whether or not accompanied by promises or threats with regard to the employment or volunteer relationship;  Sexual jokes and innuendo; verbal abuse of a sexual nature; comments about an individual's body, sexual prowess, sexual activity or sexual attractiveness; and  Leering, whistling, or touching; insulting or obscene comments, sounds or gestures; displays of sexually suggestive objects, cartoons or pictures. 3. Words, actions or visual matter that demean or show hostility toward an individual or group because of any characteristic protected by applicable federal, state or local law.

WAIVER AND RELEASE OF LIABILITY

In connection with my voluntary involvement in activities undertaken for, and / or with the participation and support of Words Alive, I, the undersigned, hereby agree, for myself, my heirs, assigns, executors, and administers to release and discharge Words Alive and its nonprofit partner agencies, its officers and directors, members, partners, funders, employees, agents, and volunteers (“Releasees”) from all claims, demands, and actions from injuries sustained to my person and / or property as a result of my involvement in such activities, whether or not resulting from negligence. I agree to release and hold Words Alive and its Releasees harmless from any cause or action, claims or suit arising there from. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk and that I have read the foregoing terms and conditions of this release. I agree that I will perform activities that I am comfortable performing and will follow all instructions. I hereby confirm, represent and warrant that I have never been convicted of, or charged with, a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I been ordered by a court to received psychiatric or psychological treatment in connection therewith.

By checking this box, I am in agreement with the aforementioned waiver.

RELEASE OF INFORMATION

By checking this box I give Words Alive, free of any compensation, unlimited permission to use, publish and republish, in any media now in existence or that may later be developed for any lawful purpose as it may determine, information and reproduction of my likeness, voice, and written comments related to any aspect of my volunteer service for Words Alive.

VOLUNTEER REQUIREMENTS

1. All prospective volunteers are required to attend an orientation session, interview, and trainings as the organization deems necessary. 2. Volunteers are required to commit to a regular weekly or monthly schedule (depending on position) for the duration of the position. 3. Volunteers should be polite and helpful at all times. All peoples are to be treated with respect and courtesy. 4. Volunteers are required to adhere to the rules explained in the training as it pertains to a specific position. 5. Volunteers are ambassadors for Words Alive, always promoting it in a way that is aligned with the mission and vision. 6. All questions from public that cannot be readily and correctly answered and all media inquiries and questions are to be directed to professional staff. 7. Volunteers must accept the guidance and decisions of the professional staff persons, volunteer leadership and others designated responsible for oversight of the position. 8. Volunteers are responsible for reporting their hours and maintaining personal calendars to ensure availability for positions. Reasonable notice (six hours minimum) is required if unable to fulfill a commitment. 9. Volunteers working directly with children are required to submit a current negative TB test prior to program involvement. No volunteer will be placed without a negative test on file at Words Alive. 10. Volunteers working directly with children are required also to undergo a background check prior to program involvement. No volunteer will be placed without a background check that provides proof of safe employment in the school system. 11. Volunteers or guests may not participate as part of a program or committee meeting without proper training, permission and/or supervision.

VOLUNTEER AGREEMENT

I have been given the above information voluntarily, and I certify that all statements and representations are true and correct. I understand that an application is not a guarantee of acceptance and that in case violations of Words Alive code of conduct and policies, I can be dismissed as a volunteer. I understand that Words Alive will use this information as part of its verification of my volunteer application. I understand that it will be used and disclosed for Words Alive purposes only. I understand that I will not be paid for my services as a Words Alive volunteer. I have read, understand, and agree to fully abide by Words Alive volunteer personnel policies and agreements (Code of Conduct, Confidentiality and Intellectual Property, Harassment Free Workplace, Release of Information, Waiver/Release of Liability and Volunteer Requirements). I have read, understand and agree to abide fully by Words Alive mission and its fundamental principles and values.

Name

First Name

Last Name

Date

YYYY