" I Have A Dream" Safety Application

Page 1

Volunteer Authorization to Conduct Annual Background Check and/or a Motor Vehicle Report and References

All volunteers, please read and provide your initials below.


I hereby authorize the “I Have A Dream” Foundation to contact the references I’ve provided, verify my academic credentials, conduct a criminal background investigation, conduct a fingerprint search, and/or a motor vehicle report, as a part of my application for volunteer service and/or employment; and annually following my start date while actively volunteering. I hereby agree to submit a valid form of ID. If I plan on transporting my mentee, I hereby agree to submit a copy of my driver’s license and a proof of car insurance.
Please provide your legal first name.
Please provide your legal last name.
Academic-based mentors provide academic mentoring and homework help to youth in grades K-12. Community-based mentors focus on developing a positive relationships with Dreamers in grades 1st-12th. They serve as role models and plan outings with their mentees.
Please use the same email you used on the Mentor Application. If unsure, contact your local IHDF staff member.
This information will be used solely to run formal background checks.
Valid forms of identification include a driver's license, state issued identification card, passport, green card, military ID card, etc.
Primary Address Information
Include apartment number if applicable.
Past Address Information
Please any list any additional addresses of residence if in a different state that in the previously recorded address.
Include apartment number if applicable.
Second Address Information
Please any list any additional addresses of residence if in a different state that in the previously recorded addresses.
Include apartment number if applicable.
If no is selected, you are forbidden from driving Dreamers under any circumstance.

Page 2

Media Release

I acknowledge that I may be photographed or videotaped, from time to time in my role as a volunteer with “I Have A Dream”. For valuable consideration received, I hereby grant to “I Have A Dream” perpetually, exclusively, and for all media throughout the world (including print, non-theatrical, home video, CD-ROM, Internet and any other electronic medium presently in existence, or, invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs or video footage taken of me, as a result of my participation in “I Have A Dream” activities (“the Property”). I hereby agree that I will not bring, or consent to others bringing, claim or action against “I Have A Dream” on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith is defamatory, reflects adversely on me, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release “I Have A Dream,” its Board Members, Staff, AmeriCorps Members, Mentors, Tutors, and other Volunteers from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities and damages whatsoever that I may hereafter have against “I Have A Dream” in connection with the Property. This agreement shall not obligate “I Have A Dream” to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute, or exploit, the Property. “I Have A Dream” shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, or corporation.

Equal Employment Opportunity/Unlawful Harassment

The “I Have A Dream Foundation” (IHDF) organization is dedicated to the principles of equal employment opportunity. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, gender, gender identity, color, religion, national origin, disability, military status, genetic information, or any other status protected by applicable state or local law. This prohibition includes unlawful harassment based on any of these protected classes. Unlawful harassment includes verbal or physical conduct, which has the purpose or effect of substantially interfering with an individual’s work performance or creating an intimidating, hostile, or offensive work environment. This policy applies to all employees, including managers, supervisors, co-workers, and non-employees such as volunteers, customers, clients, vendors, consultants, etc. Any questions, concerns or complaints will be taken seriously and fully investigated. Employees should follow the complaint procedure outlined in the handbook. 


IHDF Volunteer Disclaimer

Upon completion of the volunteer intake process, anything you have shared on your application and during the interview could be shared at the discretion of the staff at “I Have A Dream” Foundation and/or with other IHDF staff as deemed necessary. In addition, there is no guarantee of your approval as a volunteer, nor is there a guarantee “I Have A Dream” Foundation will be able to place you or utilize your skills. During any time of the intake process and/or the volunteer experience, we reserve the right to dismiss and/or terminate candidates and active volunteers at any time without explanation or reason.


Page 3

Volunteer Code of Conduct

All volunteers, please read and provide your initials below.


As a mentor with “I Have A Dream” Foundation, I agree to:


  • Fulfill my volunteer commitment with the “I Have A Dream” Foundation to the best of my ability.


  • Act as a positive role model encouraging high academic standards and emotional growth in Dreamers/Dreamer Scholars; encourage high academic standards and emotional growth; be consistent, dependable and not make promises I cannot keep; model the same behavior expected of the Dreamers/Dreamer Scholars.


  • Dress appropriately and abide by all dress codes; act appropriately including: no engaging in the use of alcohol and/or substances prior to meeting with or during contact with Dreamers/Dreamer Scholars, alcohol/substance abuse, profanity and inappropriate language, discussion of, or dissemination of, inappropriate subjects, or taking/sharing inappropriate photos. 


  • Not record video, audio, or take photos of Dreamers/Dreamer Scholars, IHDF Staff members, or IHDF volunteers/tutors without permission and authorization from the IHDF Staff. Exception: Community-Based Mentors are allowed to take photos of match activities and are asked to share with the Program Director (PD), Program Coordinator (PC), Mentor Coordinator, and/or Director of Volunteers.


  • Not engage in social media with Dreamers/Dreamer Scholars and restrict my accounts such that Dreamers/Dreamer Scholars do not have access to any potentially inappropriate content connected with my accounts.


  • Not initiate and/or engage in any virtual contact with Dreamers/Dreamer Scholars unless approved by the Volunteer Department and Program Director (PD) and supervised by a program staff member.


  • Direct all conflict resolution, incidents, and behavior issues to IHDF staff and will not touch or physically redirect Dreamers/Dreamer Scholars for any reason.


  • Volunteer as scheduled and contact in advance the Program Director (PD), Program Coordinator (PC) or the Department Director, Manager, or Mentor Coordinator working with me, if I am unable to attend.  


  • Address any questions, issues, or concerns directly with the staff person responsible for providing me with instructions, training, supervision, etc. and will inform them if/when I need to end my volunteer service.


  • Immediately tell the PD/PC, and/or Mentor Coordinator, IHDF staff if you have reasonable concern, know, or suspect a Dreamer/Dreamer Scholar has been subject to abuse or neglect.


  • Refrain from being alone and unsupervised with Dreamers/Dreamer Scholars without having specific authorization from the site PD/PC and/or Mentor Coordinator. I acknowledge that this requires additional screening and training requested only by the PD/PC and/or Mentor Coordinator. Mentors approved by the Director of Volunteers/Mentor coordinator are an exception.


  • Never laugh at a student’s mistake or be surprised by their lack of knowledge. Do not assume what a student should/shouldn’t know. Work to empower students and help them increase their self-esteem and self-respect.


  • Support the Dreamers/Dreamer Scholars’s quest for all post-secondary options (college, higher education, vocational school, meaningful career, etc.).

  • Exercise appropriate confidentiality by not sharing, revealing and/or discussing personal information, records, forms, names, etc. outside of the organization that have been shared with you confidentially and/or unless given permission or made public by the organization. This includes refraining from utilizing volunteer email addresses and other contact information to discuss and/or promote non-program related information or questions (including political campaigning).

  • Academic Mentors/Volunteers are allowed to communicate with Dreamers/Dreamer Scholars via phone only during program hours. In the case of a Dreamers/Dreamer Scholars not being at the program on time (virtually or in-person), Volunteers may send a group message to the Dreamers/Dreamer Scholars, but must include the Program Director and Program Coordinator in the message. Direct communication must be program related.


  • Update the Volunteer Department if your contact information changes (address, phone, email, etc.)


I have been provided a copy of the Volunteer Orientation Handbook and have read through it and understand my role(s) and responsibilities. 


Page 4

Mentor Responsibilities

All volunteers, please read and provide your initials below.


As a mentor with “I Have A Dream” Foundation, I agree to:

  • Volunteer with Dreamers/Dreamer Scholars for a minimum of one academic year for at least once a week for elementary mentees, twice a month for middle school mentees, and once a month for high school mentees. I agree to follow the “I Have A Dream” Foundation policies and procedures as outlined in the Volunteer Orientation Handbook and/or Training Manual shared with me.


  • Attend a required mentor training before beginning volunteer commitment; take advantage of additional  training opportunities and resources provided by “I Have A Dream” designed to improve my skills as a mentor.


  • Submit a virtual form after each contact with my mentee.


  • Coordinate and confirm activities in advance with the mentee and their parent(s)/guardian(s), and in some instances with the PD/PC and/or Mentor Coordinator if wanting to attend a program or pick up a mentee at the program site with permission.


  • Show up as scheduled and contact the mentee and their parent(s)/guardian(s) in advance to cancel or reschedule.


  • Contact IHDF if communication with the mentee and/or parent(s)/guardian(s) becomes an issue or to address questions/issues/concerns. 


  • Never intercede for the parent.  If the Dreamers/Dreamer Scholar has a conflict with the law, school, etc. their parent is responsible for the child. Only become involved if the PD/PC and/or Mentor Coordinator asks you to/approves your involvement. 


  • Not engage in any overnight activities during the first year. After the first year, request permission from the PD/PC and/or Mentor Coordinator and parent(s)/guardian(s), and will complete IHDF’s overnight permission form given to me by the PD/PC and/or Mentor Coordinator.


  • Contact PD/PC and/or Mentor Coordinator when match closure becomes necessary (moving, job change, health, any major change in status that could affect your ability and/or availability to continue with commitment). Sign and submit a closure form to PD/PC and/or Mentor Coordinator when requested.


Note: Mentors are expected to fulfill the one year commitment. It is highly discouraged to end the relationship prematurely, as this can have a potentially negative impact on Dreamers/ Dreamer Scholars and/or their families, and any future requests to return as a volunteer.

Page 5

Academic Mentor Agreements

All Academic Mentors, please read and provide your initials below.


As a mentor with “I Have A Dream” Foundation, I agree to:

  • Volunteer with Dreamers/Dreamer Scholars for a minimum of one academic year for at least once a week for elementary mentees, twice a month for middle school mentees, and once a month for high school mentees. Volunteers must agree to follow “I Have A Dream” Foundation policies and procedures as outlined in the Volunteer Orientation Handbook and/or Training Manual shared with me.


  • Show up 10-15 minutes prior to the beginning of the programming/tutoring session and stay 10-15 minutes after.


  • Follow the direction of the on-site Program Director (PD), Program Coordinator (PC), and/or Mentor Coordinator and AmeriCorps Members and support them in engaging the Dreamers/Dreamer Scholars in program activities/homework.


  • Refrain from contact (e.g. tutoring, grabbing coffee, shooting hoops, etc.) with Dreamers/Dreamer Scholars outside of scheduled program hours, or tutor in a Dreamer Scholar’s home unless specifically authorized by "I Have A Dream” staff (PD/PC, and/or Mentor Coordinator, and Volunteer Department Staff).


  • When volunteering at a school site:  follow all school policies and leave the tutoring areas tidy.



Page 6

Risk Acknowledgement and Release of Liability

We recognize that volunteers who have underlying health conditions may be at higher risk than others. If you have any questions about your health risks when volunteering for IHDF, please consult your physician to take appropriate precautions. In addition, we ask that you acknowledge that volunteering poses known and unknown risks, including exposure to viruses, injuries, or encountering someone who has COVID-19 as a result of your volunteer activities. 

All volunteers of the “I Have A Dream'' Foundation (IHDF) are being asked to acknowledge the risk inherent in serving as a volunteer. IHDF requires that all volunteers adhere to state, local and IHDF policies related to COVID-19.

Currently not showing signs of the virus

I am not currently showing signs of the virus and to my knowledge have not been in direct contact with someone who is showing signs of the virus. I do not have a fever, am not coughing or having difficulty.


I acknowledge the risks of being exposed to COVID-19 while volunteering with the “I Have A Dream” Foundation, which include serious illness or death. I am choosing on my own free will to volunteer with the "I Have A Dream" Foundation. I will not hold "I Have A Dream" Foundation, its representatives, officers, agents, and employees accountable for any actions, claims or demands for injuries, damages or loss resulting from my volunteering at the "I Have A Dream" Foundation.


Page 7

References for Volunteer Applicants

ALL references must be individuals who have known you for at least one full year and have observed you working with children, if applicable.

Reference 1
Reference 2

Contact Information