Pcssd Pals Form PDF Details

In an era where community involvement in educational institutions is increasingly recognized for its vital contribution to student success, forms such as the People Assisting Local Schools (PALS) Volunteer Application become essential tools in building a solid foundation for such partnerships. This comprehensive application form, created by the Pulaski County Special School District (PCSSD), is designed to facilitate the engagement of enthusiastic volunteers eager to contribute their time and skills to local schools. At its core, the form collects basic personal information including the volunteer’s name, address, occupation, and contact details, ensuring a starting point for background checks and further communications. It delves deeper by inquiring about potential criminal records, specific skills and interests, previous volunteer experiences, and any disabilities that might influence volunteer activities. Crucially, the form offers a selection of volunteer opportunities, allowing individuals to indicate their preferences for roles such as mentor, tutor, or reader, among others, and the school level they are interested in assisting with. Additionally, the application accommodates scheduling preferences, highlighting the program’s flexibility to incorporate volunteer support at convenient times for both parties. Embedded within this process is a mandatory authorization for the release of confidential information from the Arkansas Child Abuse and Neglect Central Registry, underlining the district’s commitment to safeguarding the well-being of its students. This adjunct requirement not only ensures the safety of the children but also reinforces the integrity of the volunteer program. Taken together, the PALS Volunteer Application represents a meticulous approach to assembling a community-based support system for schools, demonstrating the PCSSD's dedication to creating enriching environments for both students and volunteers.

QuestionAnswer
Form NamePcssd Pals Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestopresent, Signatureofapplicant, ApplicantsRace, containindicatingtheunde

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PALSPeople Assisting Local Schools

Volunteer Application

Originating School _____________________________ Date________________

Name: _______________________________________________________________________

LastFirstMiddle

Address: ______________________________________________________________________

StreetCityZip Home phone

Occupation: ___________________________________________________________________

Employer

Position

Work phone

E-mail address: ______________________________

Cell phone: _____________________

Have you ever been convicted of, or are you currently being charged with any felony? _____

If yes, please explain: ___________________________________________________________

Special skills & interest: ________________________________________________________

Volunteer experience: ___________________________________________________________

Do you have any disabilities that might affect your involvement? ______________________

Which volunteer opportunities are you most interested: (check all that apply)

_____ Mentor

_____ Tutor

_____ Reader

_____ Resource speaker

_____ Clerical/ staff assistance

_____ Field Trip Chaperon

_____

School activities

_____ Recess/ lunch monitor

_____ Other ___________

_____

Elementary School

_____ Middle School _____ Senior High _____No preference

School (s) preferred: ____________________________________________________________

What time/ day works best for you: (check all that apply)

 

_____ Monday _____ Tuesday _____ Wednesday

_____ Thursday _____ Friday

___ Morning ___ Lunch ___ Afternoon ___ Flexible

___:__ am/pm to __:___ am/pm

Authorization for release of confidential information to the Pulaski County Special School District

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Authorization for release of confidential information contained within the

Arkansas Child Abuse and Neglect Central Registry.

I hereby request that the Arkansas Child Abuse and Neglect Central Registry release any information that their files may contain indicating the undersigned applicant as an alleged perpetrator of suspected child abuse/neglect. This information should be addressed to͗

Communications Department Pulaski County Sp ecial School District

925 East Dixon Road

Little Rock, AR 72206

I understand that the name of any confidential informants, or other information which does not pertain to the applicant as alleged perpetrator, will not be released.

______________________________________________________________________________________

Applicant’s name (print)Maiden name/aliasesSocial Security number

______________________________________________________________________________________

Applicant’s Race

Age

Date of birth

Driver’s License number

List your addresses for the last 7 years:

List all of your children, and any whom you

 

 

serve as legal guardian, by their full name.

 

 

Include their date of birth by month/date/year:

From __________________to present:

 

 

______________________________________

___________________________________________

 

 

Name

DOB

______________________________________

 

 

From _________________to _____________:

___________________________________________

 

 

Name

DOB

______________________________________

 

 

 

 

___________________________________________

______________________________________

Name

DOB

From _________________to _____________:

___________________________________________

 

 

Name

DOB

______________________________________

 

 

 

 

___________________________________________

______________________________________

Name

DOB

From _________________to _____________:

___________________________________________

 

 

Name

DOB

______________________________________

 

 

 

 

___________________________________________

______________________________________

Name

DOB

Signature of applicant:______________________________ Date: ________________________________________

A notary must complete the following:

County of___________________________) SS

STATE OF ARKANSAS

)

Acknowledged before me, this ____ day of _________,20 ___.

My commission expires:

____________________________________

Notary Public