Confidentiality Agreement
“Confidential Information” is any information in any media that is not generally known to the
public and cannot be readily obtained by proper means by the general public. Confidential
information includes, but is not limited to, (1) information relating to the mental or physical
health of an individual or individuals, (2) names and other identifying information about
individuals, (3) financial details of an organization or individual, and (4) background or personal
information told in confidence.
I, the undersigned, recognize that my position as a volunteer for the Vermont Migrant Education
Program (VMEP) requires considerable responsibility and trust. I understand that I may be
entrusted with sensitive and confidential information in the course of my volunteer work.
I particularly acknowledge my awareness that the following categories of information are
protected by state or federal law: medical records; education records; financial records; and
social security numbers.
I agree not to improperly use or disclose any Confidential Information that is disclosed to me as
a result of my serving as a volunteer of VMEP except as required to perform my duties. I agree
to bring any questions or concerns about this agreement directly to my VMEP supervisor, Erin
Shea.
Printed Name ______________________________________
Signed Name ______________________________________
Date _____________
617 Comstock Road, Suite 5, Berlin, VT 05602-9194
(802) 223-2389 or 1-866-860-1382
Fax: (802) 223-6500
Cultivating Healthy Communities
UVM Extension has offices throughout Vermont.
For more information, contact this office or visit www.uvm.edu/extension.
University of Vermont Extension and U.S. Department of Agriculture, cooperating, offer education and employment to everyone without
regard to race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or familial status.