School Volunteer Form Packet

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Anderson School District Five
P.O. Box 439 / 400 Pearman Dairy Road Anderson, SC 29622
Phone: (864) 260-5000  Fax: (864) 260-4463  www.anderson5.net
Dear Volunteer:
We appreciate your willingness to volunteer in our schools. Having caring and compassionate
volunteers working with our young people is a priority of District Five. Another priority of the
District is the safety and security of our students. We work very hard to ensure that our students
are provided with a safe and secure environment on a daily basis.
With our students’ safety in mind, District Five requires a background check on any individual
who will be in a supervisory role or in direct contact with a District Five student or students. For
example, tutors, volunteers, and field trip chaperones must all have background checks before
working with our students. The type of background check completed is dependent upon the
volunteer’s role at the school. At a minimum, the district will perform a National Sex Offender
Registry check on all volunteers. A South Carolina SLED check may be required for volunteers
with close contact with students.
Parents visiting our schools as guests that have not been assigned responsibilities with students
are not required to have background checks. However, all visitors are required to sign-in upon
arrival at the school. Schools with the appropriate technology may run a driver’s license check
on all visitors.
If you would like to be involved in your child’s school as a volunteer, it is vital that you complete
all sections of the volunteer form; printing clearly and legibly with accurate information. If you
have a child at multiple schools in District Five, only one background check is required. Please
alert the appropriate school(s) that you have a background check on file with the district. All
background checks are strictly confidential. Only appropriate district and school level
administrators will have access to your background information.
We feel that protecting the children in District Five is a major responsibility of our schools and
district: therefore, we hope that you understand the need for us to be diligent and thorough in
our screening of volunteers.
Thank you for your cooperation in this matter.
Most sincerely,
Betty Bagley
Betty Bagley
Superintendent
Anderson School District Five
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revised Sept. 2010
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Anderson School District Five
Background Checks
SLED = State Law Enforcement Division
NSOR = National Sex Offender Registry
Employee Type
Check Conducted
Cost
SC Teachers, Substitutes, Teaching Assistants
SLED
NSOR
None
None
Clerical Staff
SLED
NSOR
$25.00
None
Bus Drivers and Assistants
SLED
NSOR
Driver’s License Check
None
None
Buildings and Grounds and Food Service
SLED
NSOR
$25.00
None
Any Out-of-State Employee
SLED
NSOR
SS Trace
County Criminal Records Check
None
None
$3.00
$10.00
Volunteer Type
Check Conducted
Cost
School Volunteer/Tutor with no student one-on-one
responsibilities
NSOR
None
None
School Mentor (must meet SLED’s definition of a mentor)
SLED
NSOR
$8.00
None
School Volunteer/Tutor with student
one-on-one responsibilities
SLED
NSOR
$25.00
None
School Chaperone with overnight responsibilities
SLED
NSOR
$25.00
None
School Chaperone with no overnight responsibilities
NSOR
None
None
School Volunteer with transportation responsibilities
SLED
NSOR
ACCRC
$25.00
None
None
SLED
NSOR
$25.00
None
Student Teachers and Jr/Sr Level Practicum Students
with student one-on-one responsibilities
Student Volunteers and Fr/So Level Practicum Students
with no student one-on-one responsibilities
(Paid by college)
NSOR
(completed and submitted by the college)
None
None
SCL 8/10
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Anderson School District Five
revised Sept. 2010
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Volunteer and Mentor Background Checks
District Five has developed the following background check procedure to continue to ensure the safety of our
students.
VOLUNTEERS
Background checks are required of any volunteer that will be in close proximity to a student or students and who
may be given supervisory responsibilities. Examples include a field trip chaperone, tutor, mentor, driver of
students to events, etc.
Schools will request a background check by submitting a completed Volunteer Background Check form to Carol
Buck at the District Office.
The background check will include a search of the National Sex Offenders Registry. For volunteers requiring a
SLED check, we will check our SLED records going back THREE years. SLED checks older than three years will
have to be resubmitted. Other county records may be checked as necessary.
Volunteers that have approved SLED checks on file with the district that are no more than three years old will be
accepted pending a National Sex Offenders Registry check.
In addition, volunteers for overnight activities, one-on-one tutors, mentors, and adults that drive students, other
than their child, to events in lieu of district transportation MUST have a SLED check.
Schools may also request a SLED check on all of their volunteers but will be responsible for the $25.00 fee for the
background check.
MENTORS
The District Five Mentor Program was delegated to schools when the District Volunteer Coordinator position was
eliminated. Schools that wish to implement a mentor program should request the district training materials from
Wanda Whitfield in order to train mentors. Mentors must be trained, have a SLED check, and have a National Sex
Offenders Registry check completed before becoming a mentor. SLED checks are $8.00 for mentors that meet
SLED’s requirements. Otherwise, the SLED check is $25.00.
PROCEDURE FOR SUBMITTING VOLUNTEER FORMS
 Have the volunteer complete a School Volunteer Form.
 Submit the School Volunteer Form to Carol Buck at the District Office.
o Attach a check(s) to cover the cost of the SLED check if required
o Schools that cannot write checks should submit a Disbursement Voucher and a copy of the School
Volunteer Form to Gloria Brown at the District Office
 Once the background check is complete, Carol Buck will forward the results back to the school principal.
Questionable results are discussed with the principal. The principal will make final decision as to which
volunteer(s) are included or excluded from serving.
When to send background check forms for FIELD TRIPS:
 Background check forms for field trips should be submitted no more than four (8) weeks prior and no less
than one (1) week before the field trip.
Anderson School District Five
revised Sept. 2010
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Sept. 2010
ANDERSON SCHOOL DISTRICT FIVE
School Volunteer Form
TO BE COMPLETED BY ALL VOLUNTEERS HAVING A SUPERVISORY ROLE WITH STUDENTS.
PRINT ALL RESPONSES USING BLUE OR BLACK INK
First
Name
Middle
Name
Last
Name
Maiden
Name
Address
City
State
Zip
Gender (circle)
Phone #’s
M
F
Race
(H)
(W)
(C)
Date of Birth
Month
Day
Year
Area(s) in which you wish to volunteer: Please check below all that apply
Tutor
School Volunteer
Chaperone
Other – describe
SLED CHECK REQUIRED FOR THE FOUR (4) AREAS BELOW
Mentor (Must complete the Mentor Application)
Overnight Chaperone
One-on-One Tutor
Approved driver of students to events
Have you served as a tutor or chaperone in one of our schools before?
YES
NO
If YES, which school(s)
Child’s Name
Grade
Anderson School District Five promises to provide a safe, nurturing environment for our students. We respectfully
request that all volunteers having a supervisory role with students complete a background check. All of our
school employees do this at time of hire. All background check information is confidential and is kept in
accordance with state, federal and local regulations. Thank you so much for helping our students and our
schools!
Signature: _______________________________________________ Date: _______________
Principal’s Signature: _______________________________ School: _________________________
Anderson School District Five
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ANDERSON SCHOOL DISTRICT FIVE
MENTOR BACKGROUND CHECK
PERSONAL INFORMATION RELEASE FORM
Last Name
First Name
Current Street Address
Middle Name
City
State
Zip Code
E-Mail Address
Please list any additional addresses residences in the last 7 years (most current first).
Street Address
City
State
Zip Code
Street Address
City
State
Zip Code
Would you prefer to be matched with a male student or female student?  Male
 Female
 No Preference
What grade level of child do you prefer? K-2 _____ 3-5 _____ 6-8 _____ 9-12 _____
What special skills do you feel you have to offer a young person?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
For the protection of our children, we ask you to respond to the following questions. Thanks for understanding.
Have you ever been charged with and/or convicted of a criminal offense? YES ___ NO ___
If YES, please explain in detail: __________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Have you ever been investigated, charged, or convicted of child abuse, neglect or any other offense involving a child?
YES ___ NO ___ If YES, please explain in detail: ___________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
If you have a school preference, please name the school: _____________________________________________________
By signing below, you are authorizing Anderson School District Five to secure any and all personal information from any
source of record that they deem necessary in order to perform a background check on you. You further authorize and release
District Five from legal liability for collecting and reporting your personal background information.
All background check information is confidential and is kept in accordance with state, federal and local regulations. Thank
you so much for helping our students and our schools!
_____________________________________________
Mentor Applicant Signature
_________________________________________
Date
When completed, please return to: Tripp Dukes, Assistant Superintendent, P.O. Box 439, Anderson, SC 29622 or fax to 864-260-4463.
Anderson School District Five
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REDUCED FEE NAME BASED CRIMINAL RECORDS CHECKS FROM SLED
MENTOR INFORMATION FOR SCHOOLS
AUGUST 13, 2009
Section 23‐3‐115 (B), SC Code of Laws states:
“(B) The fee allowed in subsection (A) is fixed at eight dollars if the criminal record search is
conducted for a charitable organization, a bona fide mentor, or for the use of a charitable
organization. The division shall develop forms on which a mentor or charitable organization shall
certify that the criminal record search is conducted for the use and benefit of the charitable
organization or mentor.”
For reduced fee name based criminal records checks for mentors, all of these requirements must be
met:
1. The mentor must be part of an organized and documented mentoring program at the school.
2. The mentoring program documentation must be available for submission to SLED upon request.
3. The mentoring program must require a commitment of one semester.
4. The mentoring program must require a minimum of 4 hours of work per month.
5. The mentoring must occur at the school and must occur before, during, or after the school day.
6. Based on the school district’s guidelines, the mentor must be qualified to assist with the schoolwork.
7. The mentor must focus a minimum of 75% of their time directly assisting students with their
schoolwork.
8. The mentor must assist students with schoolwork which is part of the normal school day curriculum.
9. The mentor must not receive any monetary compensation for the school for any reason.
10. For reduced fee checks for mentors, the school district must maintain a log for submission quarterly
to SLED.
Anderson School District Five
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Policy
Dear Volunteer,
Please read the Anderson School District Five Policy on Staff Conduct.
Sign below indicating that you have read and understand this policy.
This form should be returned to the volunteer coordinator.
STAFF CONDUCT
Code
GBEB Issued 7/03
Purpose: To establish the board's vision for appropriate staff conduct.
The board reaffirms one of the oldest beliefs in education: One of the best methods of instruction is that of setting a
good example.
The board expects the staff of the district to strive to set the kind of example for students that will serve them well
in their own conduct and behavior and subsequently contribute to an appropriate school atmosphere.
To that end, in dress, conduct and interpersonal relationships, all staff should recognize that they are being
continuously observed by students and that their actions and demeanor will be reflected in the conduct of the
students. The administration shall establish an administrative rule implementing the expectation that staff
members dress in a professional manner.
The personal life of an employee will be the concern of and warrant the attention of the board only as it may
directly prevent the employee from effectively performing assigned functions during duty hours or as it violates
local, state or federal law or contractual agreements.
Adopted 9/18/01; Revised 7/29/03
Signature
Date
Anderson County School District Five
Anderson School District Five
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revised Sept. 2010
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