Volunteer Application
Please fill out the application below.
Red indicates required fields.
If you do not have an email address, please complete a
PAPER APPLICATION
.
Are you a MINOR under 18 years of age?
No, I am 18 years of age or older.
Yes, I am under 18 years of age.
Date:
Legal First Name:
Middle Name:
Legal Last Name:
Preferred First Name:
Mailing Address:
City:
State:
Oregon
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County:
-- Select One --
Baker
Benton
Clackamas
Clatsop
Columbia
Coos
Crook
Curry
Deschutes
Douglas
Gilliam
Grant
Harney
Hood River
Jackson
Jefferson
Josephine
Klamath
Lake
Lane
Lincoln
Linn
Malheur
Marion
Morrow
Multnomah
Polk
Sherman
Tillamook
Umatilla
Union
Wallowa
Wasco
Washington
Wheeler
Yamhill
Other
Zip:
Home Phone:
(
)
-
Example: (503) 123-4567
Mobile:
(
)
-
Example: (503) 123-4567
Email:
Company/ Organization:
Office Phone:
(
)
-
Example: (503) 123-4567
In which county would you like to volunteer?
- Select One -
Click here to find a school near you.
NOTE: SMART is currently not available in Columbia, Gilliam, Harney, Lincoln, Malheur and Sherman Counties. To learn how you can help bring SMART to you community,
click here
.
I would like to be placed where the need for volunteers is greatest.
I would like to volunteer near my address (above)
.
I would like to choose my top three (3) school preferences.
Please list, in order of preference, the SMART school(s) where you would like to volunteer?
First Preference
- Select One -
Second Preference
- Select One -
Third Preference
- Select One -
NOTE: Volunteers are scheduled on a first come, first served basis. We will accommodate your preferences whenever possible.
For scheduling assistance, questions or concerns, please contact your
your local SMART representative
.
Preferred day(s):
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred time(s):
Early Morning (8-10am)
Mid-morning (10-Noon)
Afternoon (Noon-3pm)
NOTE: Certain days and times may not be available at every school or in every county.
Do you read in another language?
yes
no — If yes, please specify
How did you hear about SMART?
SMART volunteer
Employer
College/high school
Media (TV, newspaper, radio)
Service club presentation
Friend/Family
I was a SMART student.
School
Years
Other
Do you know someone interested in volunteering with SMART?
Name
Phone
(
)
-
Example: (503) 123-4567
Email
Volunteer Criminal History Check
Applicants:
• Any felony conviction will prohibit your participation as a SMART volunteer. No exceptions will be made.
• Applications will not be processed until all sections are complete.
• The Oregon Children’s Foundation dba SMART and/or the elementary school has the right to refuse participation by an individual without demonstrating cause.
List any other names you have used:
*If none, specify by typing N/A in the box
Date of birth:
Example: 05/12/2005
Gender:
male
female
Driver's License #
*If none, specify by typing N/A in the box
State Issued
Have you been arrested for a crime that has yet to be resolved?
yes
no
If yes, please specify:
State
- Select One -
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County
Year
Offense
Have you EVER been convicted of a crime except a minor traffic violation?
yes
no
Have you EVER been convicted of a crime involving drugs or alcoholic beverages?
yes
no
If yes, please specify:
State
- Select One -
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County
Year
Offense
Have you EVER been convicted of a crime involving violence, abuse, or threat of violence
yes
no
If yes, please specify:
State
- Select One -
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County
Year
Offense
Have you EVER been convicted of a sex-related crime?
yes
no
If yes, please specify:
State
- Select One -
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County
Year
Offense
Have you been convicted of any other type of crime:
yes
no
If yes, please specify:
State
- Select One -
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
County
Year
Offense
Have you EVER been asked to leave any employment or volunteer activity that involved contact with children/minors?
yes
no
SMART Volunteer Guidelines
As a SMART volunteer, I will not take children outside or away from the school.
As a SMART volunteer, I will read in view of other adults.
As a SMART volunteer, I will sign in with the school and the SMART coordinator and wear a SMART badge.
Authorization and Release
I have read and understand and commit to following the SMART safety requirements. I declare that my answers and all statements made by me herein are true and correct. All volunteers must sign the authorization below before the application can be processed. Your cooperation is greatly appreciated.
I hereby authorize Oregon Children’s Foundation, dba SMART, the school district and the Oregon Department of Education to conduct a criminal background check on me and to communicate the results of the criminal background check to SMART. I understand that the background check may be conducted by any one or more methods, including without limitation, using government and private databases and services. I understand that a criminal background check may be undertaken at any time, and may be repeated from time-to-time, while I am associated with SMART. I hereby release and hold harmless the Oregon Children’s Foundation dba SMART, the school district, the Oregon Department of Education, and each entity’s employees and agents from any and all liability whatsoever arising from or relating in any way to: any person or entity conducting the criminal background check; the disclosure of information resulting from the criminal background check; and any action which may be taken by any individual or entity based upon that information. I understand that any misdemeanor will be reported to the school principal for volunteer authorization.
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I have read and agree to the guidelines, authorization and release.