Are you looking for an easy and convenient way to stay in touch with your colleagues from the Pcssd? The Pcssd Pals Form is a great resource that can help bond members of this special community. Developed specifically for members, the form helps participants keep their contacts updated, get connected to each other, and discover news and updates about events related to the organization. With its quick setup process, users are now able to communicate easily with fellow colleagues while creating stronger connections among them. Read on to learn more about how this powerful tool can help build lasting relationships within our network!
| Question | Answer |
|---|---|
| Form Name | Pcssd Pals Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | topresent, 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 |
Cell phone: _____________________ |
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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 |
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_____ Resource speaker |
_____ Clerical/ staff assistance |
_____ Field Trip Chaperon |
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_____ |
School activities |
_____ Recess/ lunch monitor |
_____ Other ___________ |
_____ |
Elementary School |
_____ Middle School _____ Senior High _____No preference |
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School (s) preferred: ____________________________________________________________
What time/ day works best for you: (check all that apply) |
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_____ 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
Irom the &KLOG$EXVH 1HJOHFW HJLVWU\DQGRURWKHUFULPLQDOUHFRUGVHDUFKHVPXVWEHFRPSOHWHG
DQGUHWXUQHGZLWKWKLVIRUP
3$/63HRSOH$VVLWLQJ/RFDO6FKRROV3XODVNL&RXQty Special School District - 925 E. Dixon Road - Little Rock, AR 72206
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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 |
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serve as legal guardian, by their full name. |
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Include their date of birth by month/date/year: |
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From __________________to present: |
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______________________________________ |
___________________________________________ |
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Name |
DOB |
______________________________________ |
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From _________________to _____________: |
___________________________________________ |
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Name |
DOB |
______________________________________ |
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___________________________________________ |
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______________________________________ |
Name |
DOB |
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From _________________to _____________: |
___________________________________________ |
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Name |
DOB |
______________________________________ |
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___________________________________________ |
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______________________________________ |
Name |
DOB |
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From _________________to _____________: |
___________________________________________ |
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Name |
DOB |
______________________________________ |
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___________________________________________ |
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______________________________________ |
Name |
DOB |
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Signature of applicant:______________________________ Date: ________________________________________
A notary must complete the following:
County of___________________________) SS
STATE OF ARKANSAS |
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Acknowledged before me, this ____ day of _________,20 ___. |
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My commission expires: |
____________________________________ |
Notary Public