Service Learning Application


Service Learning Application
for purpose of background check: please include First, Middle, and Last name(s)
Including unmarried name if applicable
00/00/0000
this information is required for the background check process
(000) 000-0000
(000) 000-0000

Experience

Gender *
(needed for the purpose of background checks)
Personal Pronouns
(check any that apply to your identity)
Do you volunteer with other organizations? *

Finding your place with us

In the interest of protecting the safety and well-being of our students, we need to ask:

Have you ever been convicted of or plead guilty to a crime? *

The Fine Print

Media Release
I permit Read and Write Kalamazoo to take photographs, audio, and video recording of myself for the explicit purpose of chronicling, promoting, and celebrating the RAWK program. I understand that any media taken of myself taken during RAWK programming will not be used by anyone not affiliated with Read and Write Kalamazoo.
A lot of words of great importance:
As a condition of volunteering, I give permission for Read and Write Kalamazoo (RAWK) to conduct a background check on me, which may include a review of sex offender registries, child abuse, and criminal activity records. I understand that, if appointed, my position is conditional upon the staff at RAWK receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability RAWK, the employees and volunteers thereof, or any person or organization that may provide such information. I hereby grant to RAWK, and its authorized agents, vendors, officers, directors, employees, licensees, affiliates, successors, and assigns the non-exclusive, irrevocable, perpetual, world-wide right and license to use, reproduce, display, perform, edit, create derivative works of, and distribute, in whole or in part, any photographs and/or recordings taken by or of me during activities sponsored by RAWK, for any purpose, in any and all manner or media now known or hereinafter developed. By signing below, I acknowledge that I also understand that RAWK appreciates me and my enthusiasm, but I also acknowledge that RAWK is not obligated to appoint me to a volunteer position.