Friends Project Service Contract & Approval Form
Complete this form and turn it in at the beginning of your service project.
Return to Mr. Moore . Check back for approval if site is not on pre-approved list (found online). Student – YOU are to complete this form, but talk with your on-site placement supervisor to get the information.
Student Name: Contact Info: (home) E-mail(s): Agency or Program Name: Project dates: (approx. is ok) Date the project begins: Name of the person who will Supervise the student while on site: Supervisor’s position/title: Phone: ext?
This should be an adult who is aware of this requirement and the student should have already contacted them. This person does not need to be the only adult with the student the whole time, but she or he should be aware of what and how the student is doing, and be able to give an evaluation.
Year of Graduation: (cell)
Indicate the best way to contact you (Check the box next to the best method)
# hrs intended: and ending month:
Parental/Guardian Consent:
I have discussed this service placement with my child and give my permission for her/him to volunteer at the above named agency, school, or program. I understand that transportation is NOT provided by the school, and I take responsibility for providing or arranging transportation to and from this service site. I understand that as a volunteer she/he may be required to complete volunteer paperwork, training and/or volunteer hours in excess of the Bishop O’Dowd requirement, if disclosed in advance, and I will support those agency requirements.
Signature of Parent/Guardian
Printed Name
Student Agreement:
I agree to serve as a volunteer at the above named agency, school, or program to the best of my abilities, to show up when scheduled, and to notify my on-site supervisor in the event of unavoidable absence. I understand that as a volunteer I may be required to complete volunteer paperwork, training and/or volunteer hours in excess of the Bishop O’Dowd requirement, if disclosed in advance, and I agree to follow all volunteer requirements. I also agree to maintain a clear and consistent record of my volunteer hours that is accessible to my on-site supervisor.
Signature of Student If requesting approval of a new site, complete the entire back side.
■ If site is on pre-approved list, do front only.
Note: You will need to contact your on-site supervisor to complete the contact information.
7a3f046f-92b6-4377-b08e-a7a2875915ec.doc (“Goldenrod Sheet”)
Last saved: 2/26/2009
If you are requesting approval of a new Friends Project site – complete this side. (approval is needed if a site is not on the “Pre-Approved Service” list – www.bishopodowd.org)
Repeat Agency or Program Name here:
Is this program associated with a different organization? No Yes & name:
(for example, a summer camp might be run by a national organization or a church, etc.)
Repeat supervisor’s name here: Supervisor Email: Site Address: Webpage:
Title:
City
State
Zip
Does the agency contact/program supervisor prefer correspondence by
e-mail or by
regular mail?
(Please answer the following questions. Form continues on the back of this sheet. Use extra sheets or back if needed.)
What is the purpose of the agency or program? (Why does this agency/program exist, what do they do, who do they work with?
If this is a trip, where will you be going (country, city or area) and what is the main goal of the trip?)
What specific activities will the volunteer be doing? Please be as specific as possible. If this is a “week long,” immersion, or overnight experience, please give a sample daily schedule.
A key component of our program is the direct, face-to-face contact our students have with people they serve. You MUST have this “hands on” contact and the opportunity to build a relationship with the people you are serving or this program will not be approved. How will this be a challenging and new experience for you the student? What do you hope to learn?
What sort of training and/or preparation will the student have before doing this volunteer work?
If for new approval, please attach any additional information which would help to explain this project or agency. The Campus Ministry Service Learning Office must approve new projects before the student may begin. The student who made the request must check back with Mr. Moore within 10 days of turning in this form to inquire about approval. Return this form to Mr. Greg Moore, Bishop O’Dowd High School, 9500 Stearns Ave. Oakland, CA 94605 or email it to: gmoore@bishopodowd.org. Phone: 510-553-8645