Volunteer Form for Student Interns and Student Fieldworkers

Step 1 of 3 - Volunteer Information

33%

Every question must be answered accurately for your application to be considered complete.
Name*
First Middle Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Emergency Contact*
The emergency contact must be 18 years of age or older.
First Name Last Name Phone Number Relationship
Do you have any current or prior experience as a school volunteer?*
- Yes
- No
At which school have you volunteered, and what year?
Are you the parent or guardian of a Hartford Public Schools student?*
- Yes
- No
Name, school, and grade of students
Name School Grade

Please specify the students name, school, and grade level. If there is more than one (1), click the (+) to add additional information.
Which school(s) are you interested in volunteering at?
- Asian Studies Academy at Bellizzi School
- Betances Early Reading Lab Magnet
- Betances STEM Magnet School
- Breakthrough II Magnet (North) School
- Breakthrough Magnet (South) School
- Bulkeley High School
- Burns Latino Studies Academy
- Burr School
- Capital Community College Magnet
- Capital Preparatory Magnet
- Classical Magnet
- Environmental Sciences Magnet at Mary Hooker
- Expeditionary Learning Academy at Moylan
- Global Communications Academy
- Great Path Academy at Manchester Community College
- Hartford Magnet Trinity College Academy
- Hartford Pre-K Magnet School
- High School, Inc.
- Hartford Public High School
- Journalism & Media Academy Magnet School
- Kennelly School
- Kinsella Magnet School of Performing Arts
- M.D. Fox School
- Maria Sanchez Elementary School
- McDonough Expeditionary Learning School
- Milner Elementary School
- Montessori Magnet at Moylan
- Montessori Magnet School at Annie Fisher School
- Naylor School
- New Visions
- Noah Webster MicroSociety Magnet School
- Parkville Community School
- Pathways Academy of Technology & Design
- Rawson School
- Renzulli Gifted & Talented Academy
- SAND School
- Sport & Medical Sciences Academy
- STEM Magnet School at Annie Fisher
- University High Magnet
- Weaver High School
- West Middle School
- Wish Museum School
What area(s) of volunteer work are you interested in?
- Tutoring –Math
- Tutoring-Language Arts/Literacy
- Arts & Crafts
- Athletics-Coaching
- Athletics-other
- School Support
- Mentoring
- Field Trips
- Translator
- Other (specify below)
Other

Have you been required to register with a state or federal sex offender registry?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Have you ever been convicted of a crime, excluding motor vehicle violations/infractions?*
- Yes
- No
List all offenses
You answered "YES" to having been convicted of a crime. List all offenses below. Click the (+) to add additional lines if you have more than one (1) offense.
Offense Date City & State
If at any time there are any changes to these responses, you are required to promptly inform the school district.

By your signature below:
1. You acknowledge that Hartford Public Schools does not provide insurance coverage for the volunteer for any loss, injuries, illness, or death resulting from the volunteer's unpaid service to Hartford Public Schools.
2. You agree to assume all risk for death or any loss, injury, illness, or damage of any nature or kind, arising out of the volunteer's supervised or unsupervised service to Hartford Public Schools, or its officers, Board of Education Members, employees, agents or assigns, for loss due to death, injury, illness, or damage of any kind arising out of the volunteer's supervised or unsupervised service to the Hartford Public Schools.
3. You consent to a criminal background investigation.
Date*
Full Name of Volunteer*
Date of Birth of Volunteer*
Initials of Volunteer*
Your initials serve as your signature and you hereby agree to all provisions and requirements of this application.

Volunteer Form for Student Interns and Student Fieldworkers

Disponible en Espanol – Haga clic aquí para completar el formulario en español.

Step 1 of 3 - Volunteer Information

QUICKLINKS

CONTACT

STAFF ESSENTIALS

Misc Links