Continuing Education - Lewis-Clark State College

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2009 Kids' College Volunteer Form

Volunteer Profile
Volunteer's Name:
Address:
City:
State:		Zip Code:
Email:	(Example: djsnyder@lcsc.edu)
Phone:	(Example: 208-792-2447)	Secondary Phone:

Volunteer References

References Please list three contacts who can speak of your character and ability to interact with youth.
Name:
Phone:	(Example: 208-792-2447; Please include area code)
Position:
Organization:

Name:
Phone:	(Example: 208-792-2447; Please include area code)
Position:
Organization:

Name:
Phone:	(Example: 208-792-2447; Please include area code)
Position:
Organization:

Background Check Permission
I have not previously had a criminal background check. You have my consent to consent to conduct a criminal background check.

I have previously had a criminal background check. You have my permission to contact my employer to verify that I have passed a criminal background screening.

Please type in your supervisor's name, e-mail address, and phone number in the box below.

Lewis-Clark State College • 500 8th Avenue • Lewiston, ID 83501 • (208) 792-5272