BSV Classroom Volunteer Application, 2023-24

Thank you for your interest in volunteering with Berkeley Schools Volunteers. This application is CLOSED to community members as of March 1, 2024.

If you have approval from a host teacher/staff member to volunteer ongoingly, please continue to complete the application below and email bsv@berkeley.net. Application submission without email communication does not guarantee volunteer clearance after March 1.

If you are associated with a Cal group/club that has approval from BSV, continue to complete the application.

----------------------------------------

This application is intended for new and returning volunteers to Berkeley Schools Volunteers who are interested in volunteering in a specific classroom, library, or garden on an ongoing basis. We require that volunteers who sign up for BSV’s Classroom Volunteer program commit for the remainder of the school year.

Thank you for your flexibility and dedication to supporting students!

Volunteer Contact Information

Name - the name that will be on your BSV Name Badge and that you regularly go by.
Please capitalize appropriately

First

Last

Legal Name - Name as it appears on your government-issued photo ID. We use this to match with your Live Scan fingerprint results. In every other way, we will only use your preferred name as listed above. If you have issues with providing your legal name, please reach out to BSV@berkeley.net and we can work with you!

Please capitalize appropriately

Pronoun(s) for BSV Name Badge. Berkeley Schools Volunteers recognizes that name and gender identity are central to most individuals' sense of self and well-being, and that it is important for us to establish systems that acknowledge and support individuals' self-identification.

she/her/hershe/him/histhey/them/theirsother (please specify below)

Other Pronoun(s)

Date of Birth:

Enter as MM/DD/YYYY

Preferred Phone Number

Phone Type

Secondary Phone Number

Phone Type

Email

Email Type

Local Mailing Address - Please include an apartment number and/or building name, if applicable
Please capitalize appropriately

Street Address

City

State

ZIP Code

Emergency Contact: Name & Relationship

First and Last Name

Emergency Contact Phone Number

BSV wants to ensure that all individuals can fully participate. Are there accommodations in the classrooms/school that you may need to perform volunteer duties?

YesNo

Please explain what accommodations are needed

I am a...

New Volunteer - I am brand new to BSV Returning Volunteer - I have attended orientation and been fingerprinted

Tuberculosis Screening

This year, we will be required to collect a negative tuberculosis (TB) screening/test from ALL long-term/ongoing volunteers. A negative TB screening lasts 4 years and we can accept a test that has been done in the last 4 years. There are 3 ways to provide proof of TB test: Risk Assessment Questionnaire (applicable if you have no history of risk factors), Skin Test, or Chest X-Ray. Visit here for more information about which test is best for you and free testing locations. Download the Risk Assessment Questionnaire here In this application, you'll be able to submit a digital copy of your TB document. If you still need to get tested, you can choose to skip this step and email me later. You will not be cleared to volunteer until you submit your documentation to BSV.

Indicate your TB status

I am ready to submit my TB documentationI have already submitted my unexpired TB proof to BSV (testing has to have been done within the last 4 years) I would like to skip this step because I need to get my testing done still. I acknowledge that this will delay my clearance to begin volunteering until proof is provided

Please enter the date of your negative TB test result (ex. 04/04/21)

Proof of Negative TB Test

Upload a document indicating your TB test (e.g. risk assessment questionnaire, negative skin test, negative chest x-ray signed by a medical provider). Note: if your documentation doesn't include a signature from your medical provider, an official medical record with the appropriate letterhead will be acceptable as well.

BSV Volunteer Contract

BSV Volunteer Contract, 2023-24 (link to PDF version here)

Section I: Qualifications & Screening

To be authorized to volunteer in BUSD, you must:

Be cleared to serve, including clearing an FBI/DOJ Live Scan background check/fingerprinting. Note: Parents volunteering in their child's classroom are exempt from the fingerprinting requirements
Provide proof of medical vaccinations (for specific placements only, as required by the California Education Code)
Be able to commit to at least 1 hour of volunteering weekly for the entire school year (unless otherwise arranged with BSV staff)

PLEASE CONFIRM

Yes, I have read, understand, and agree to Section I of the BSV Volunteer Contract.

Section II: Code of Conduct

Volunteers should:

Identify themselves to BUSD students and families as a Berkeley Schools Volunteer.
Respect the diversity of Berkeley’s students and staff, including one’s race, ethnicity, national origin, gender, sexual orientation, age, physical condition/disability status, religious beliefs, political afflictions, veteran or marital status.
Respect the school dress code, including but not limited to no clothing with logos depicting drugs, tobacco, alcohol, anything sexually suggestive, or anything involving a racial/ethnic slur.
Volunteer only under the supervision of their assigned BUSD Host Teacher.
Be punctual and consistent for all volunteer commitments.
Discuss any planned absences in advance with their Host Teacher.
Immediately refer discipline issues to their Host Teacher.
Regard any information learned as a volunteer as confidential and share only with school staff as appropriate.
Confidentially pass on knowledge or suspicion of child abuse and/or any challenges or concerns for students’ success or welfare to their Host Teacher, or designated staff.
Let BSV know immediately if they are unable to continue with their volunteer commitment, or if they change Host Teachers/placements.
Complete BSV’s annual spring volunteer survey to give BSV feedback on the program.
Update their contact information annually with BSV, as well as notify BSV of their intent to return for the following year.
Wear their current year BSV Name Badge at all times on BUSD campuses.

Volunteers should not:

Engage in any political or religious instruction, activities, or conduct
Engage in non-BUSD supervised contact with students, including texting, phoning, emailing, social media connecting, or meeting off-campus.
Photograph or post pictures/video of students without written parent and school staff permission.
Make any suggestive or inappropriate comments, or jokes.
Volunteer while ill, or with knowledge of positive testing for contagious diseases (i.e. COVID-19 or Tuberculosis, etc.).
Be under the influence of (or smell like) alcohol, marijuana, or illegal substances.
Use electronic devices (including cell phones and music players) while working with students.
Remove students from the direct supervision of the BUSD Host Teacher or from the school campus.
Physically discipline students or use hands to redirect a student.
Transport students in a vehicle (unless BUSD approved and supervised, as on a school field trip).
Remain in contact with students outside of the school context, either in-person or digitally. (Your volunteer work is sanctioned by BSV and the California Education Code only when you are under the direct supervision of a certificated teacher.)

PLEASE CONFIRM

Yes, I have read, understand, and agree to Section II of the BSV Volunteer Contract.

Section III: COVID-19 Assumption of Risk Agreement

By checking below, I assume the risk that I may be exposed to or infected by COVID-19 by participating in the Berkeley Schools Volunteers (BSV) program and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. In addition, I assume responsibility for adhering to all COVID-19 prevention measures required by BSV or Berkeley Unified School District (BUSD), and compliance with applicable federal, state or local health orders such as the use of personal protective equipment, social distancing, and general hygiene protocols. I acknowledge that it is my responsibility to make an informed participation decision, that BSV and BUSD do not control every aspect of my volunteer interactions, and that BSV and BUSD give no assurances or warranties whatsoever as to my safety if I choose to participate in this program.

PLEASE CONFIRM

Yes, I have read, understand, and agree to Section III of the BSV Volunteer Contract.

Section IV: BSV Policies

I understand and agree…

I am not an employee of the BSV or BUSD, and I volunteer my services in an “at will” capacity.
BUSD has the right to revoke my volunteer privileges at any time without prior notification or warning, in conformity with its liability and safety policies.
Any breach of the above commitments may result in my dismissal from any and all BUSD schools.

I meet the listed qualifications, understand the above expectations and restrictions, and will contact BSV if anything changes with my volunteer placement, my health in relation to communicable diseases, or my legal status related to felony convictions. I accept the appointment of School Volunteer in a BUSD school for the 2022-23 school year.

PLEASE CONFIRM

Yes, I have read, understand, and agree to Section IV of the BSV Volunteer Contract.

Electronic Signature

I understand that checking this box constitutes a legal signature certifying that the information provided above is true and correct to the best of my knowledge.

American Sign Language	Arabic	Cantonese	Farsi	Filipino
French	German	Hindi	Italian	Japanese
Korean	Mandarin	Portuguese	Russian	Spanish
Vietnamese	Other

MON morning	TUES morning	WED morning	THURS morning	FRI morning
MON early afternoon	TUES early afternoon	WED early afternoon	THURS early afternoon	FRI early afternoon
MON late afternoon	TUES late afternoon	WED late afternoon	THURS late afternoon	FRI late afternoon

MON morning	TUES morning	WED morning	THURS morning	FRI morning
MON early afternoon	TUES early afternoon	WED early afternoon	THURS early afternoon	FRI early afternoon
MON late afternoon	TUES late afternoon	WED late afternoon	THURS late afternoon	FRI late afternoon