VOLUNTEER PROCESS AND APPLICATION YMCA Youth in Government is a national program of the Y that involves thousands of teens nationwide in state-organized, model-government programs. Students from every corner of the U.S. have the opportunity to immerse themselves in experiential civic engagement and to, quite literally, practice democracy. Teens from across every state meet in their local Youth in Government groups throughout the year to discuss and debate issues that affect citizens of their state and to propose legislation. The program culminates with teens serving as delegates at their state conference, debating bills on the floor of the legislature. Massachusetts Youth in Government is committed to creating an educational, engaging and well-rounded program for teens. It takes many people to create that and offer a comprehensive program that the teens will love. Massachusetts YIG is always looking for adult volunteers with a variety of interests and backgrounds to participate with our advisors in making Youth in Government a strong and successful program To be a volunteer with Massachusetts YIG: Complete the attached application Complete the attached CORI and SORI and turn in with a photo ID Complete the online child abuse prevention training Write a letter explaining why you want to be involved with the program and what you think you bring to Massachusetts Youth in Government Please return all items to: Massachusetts Youth in Government ATTN: Caitlin Cavanagh-State Director 75 Mill St. Hanover, Ma. 023339 The management team will review all materials and be in touch to set up a time to discuss the program and what opportunities might be available.
Volunteer Application Name: Associated Delegation: Delegation advisor name: Address: Work Phone: Cell Phone: Email: Emergency Contact Information: Name: Relationship to Volunteer: Phone: Promotional Release: I hereby grant consent to release photographs and/or video footage of myself to the Massachusetts Youth in Government Program, for commercial and art purposes in any medium of advertising, communication, publication that will promote YMCA programs and services, and/or recognition of participants. It is my understanding the YMCA is a non-profit organization. Yes No Volunteer Signature: Date: Print Name:
Volunteer Medical Consent Form Name: Delegation: Gender: D.O.B: Name of Physician: Health Insurance Carrier: Policy #: Known allergies: Known medical conditions: Medications: I understand that YMCA staffs are trained in the basics of first aid and I authorize them to give me first aid as needed. I hereby authorize the program to transport me to the nearest medical care facility and secure medical treatment necessary including hospitalization, anesthesia and surgery. Alumni Signature: Date: Print name:
Volunteer Code of Conduct I understand and agree to abide by the following code of conduct as a condition to participation in Massachusetts YMCA Youth in Government. My signature is required and indicates my agreement with the code of conduct. I will model caring, honesty, respect and responsibility for the members of my delegation. I will take responsibility for my delegation s adherence to the Youth in Government requirements and expectations. I will adhere to the dress code for Massachusetts YMCA Youth in Government functions. I will be aware at all times of the whereabouts of my delegates at Youth in Government functions. I understand that I am on duty while at the conferences, and will not leave the premises except with my delegation. If I am temporarily unable to personally supervise my delegates, I will arrange for another adult advisor to temporarily fill in for me. I will be aware of the actions of all delegates, not just my own, and will intervene where appropriate when I observe unacceptable behavior. I will not bring or consume any alcohol, drugs or tobacco at any Massachusetts YMCA Youth in Government event, including in my hotel room during the model conference. I will not enter the hotel room of members of the opposite sex at any time unless accompanied by an advisor of that same gender. I understand that all hotel room assignments for my delegates are made in advance by the Housing Coordinator and may not be changed by me. I will wear my Youth in Government badge, the official credential for access to Youth in Government functions, at all Youth in Government activities. I understand that visitors who are not part of the program are not permitted at the conferences. If I observe anyone present who is not part of the program, I will report this to the State Director. I agree to treat the hotel, the State House and all other facilities made available to Youth in Government with the greatest of respect. I understand that backpacks, coats, and hats are not permitted inside the chambers of the State House. I understand that Massachusetts YMCA Youth in Government is not responsible for lost or stolen articles. I have read, understand and will abide by the Code of Conduct. Alumni Signature: Date: Print Name:
Volunteer Dress Code Massachusetts Youth in Government strives to instill a sense of professionalism in all of its participants. As a YMCA program, appropriate dress is required at all times. Attire will not: Create a disturbance Be sexually suggestive Relate to drugs, alcohol or tobacco Contain obscenities Be offensive or inflammatory to group or individuals General Guidelines: All clothing should fit appropriately and should not over expose the body Shorts and skirts/dresses must come to your fingers Head covering are not to be worn in any building Program Specific Guidelines: The dress code applies to all delegates and advisors of the Youth in Government program Gentleman will wear collared shirt and tie with slacks and appropriate footwear. Blazers or suits are optional sweaters can be worn Ladies will wear skirts, slacks or dresses. Skirts and dresses must reach fingertips. Any sleeveless shirt or dress must be worn with a sweater or blazer. Appropriate footwear required Business casual is specified for Officer s Training. Slacks/khakis or skirt, polo shirt, dress shirt or top and appropriate footwear Informal clothing may be worn for the dance, but should provide conservative coverage no midriff tops or tops with spaghetti straps, see-through clothing or bare-back tops, or visible underwear. I have read the Youth in Government Dress code and understand that compliance is required at all Youth in Government events. I understand that I may be asked to change my clothes or leave events due to inappropriate attire. Signature: Date: Print name:
CRIMINAL OFFENDER RECORD INFORMATION (CORI) For South Shore YMCA Use Only Supervisor Requesting Department Branch Volunteer General Employee Camp Employee The South Shore YMCA is registered under the provisions of M.G.L. c. 6, 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing. As a prospective or current employee, subcontractor, volunteer, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to The South Shore YMCA to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing The South Shore YMCA with written notice of my intent to withdraw consent to a CORI check. FOR EMPLOYMENT OR VOLUNTEER PURPOSES ONLY: The South Shore YMCA may conduct subsequent CORI checks within one year of the date this Form was signed by me provided, however, that The South Shore YMCA must first provide me with written notice of this check. By signing below, I provide my consent to a CORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate. PRINT NAME SIGNATURE DATE
SUBJECT INFORMATION: Last Name First Name Middle Name Suffix Maiden Name (or other name(s) by which you have been known) Date of Birth Place of Birth Social Security Number (required) : Sex: Height: ft. in. Eye Color: Race: Driver s License or ID Number: State of Issue: Mother s Full Maiden Name Father s Full Name Name Current and Former Addresses: Street Number & Name City/Town State Zip Street Number & Name City/Town State Zip The above information was verified by reviewing the following form(s) of government issued identification: VERIFIED BY: Name of Verifying Employee (Please Print) Signature of Verifying Employee
SORI REQUEST SOUTH SHORE YMCA The Commonwealth of Massachusetts Sex Offender Registry Board will provide a report that includes the following information: whether the person identified is a sex offender with an obligation to register, the offense(s) for which the offender was convicted or adjudicated, and the date(s) of the conviction(s) or adjudication(s). Please be advised that the law only permits the public to receive information on sex offenders required to register and finally classified by the Board as a level 2 (moderate risk) or level 3 (high risk) offender. Therefore, information is not available to the public if the identified individual is a level 1 (low risk) offender or if he/she has not yet been finally classified by the Board. All requests shall be recorded and kept confidential, except to assist or defend in a criminal prosecution. The information below is correct to the best of my knowledge. APPLICANT/EMPLOYEE INFORMATION (Please Print CLEARLY) LAST NAME FIRST NAME MIDDLE NAME MAIDEN NAME OR ALIAS (if applicable) DATE OF BIRTH / / SOCIAL SECURITY #: - - ADDRESS: Applicant/Employee Signature REQUESTED BY: SIGNATURE OF SORI AUTHORIZED EMPLOYEE