District 6 Gives Back Participation Form

You will need these items to complete this form.

Supervisor's work email

Volunteer organization contact name and email

Date you will participate

Hours you will participate

Volunteer Information

Please provide a little information so we know who you are and where you work.

D6 Worksite Location*

At what site do you work?

Select

Supervisor's Work Email*

Select your supervisors email who has approved your voluntary leave opportunity.

Select

Approval *

Has your supervisor approved your volunteer opportunity during the contract day?

Yes

Sponsoring Organization

Now tell us about the Greeley or Evans organization where you are volunteering

Volunteer Organization Contact Name*

Who is the person you will contact at this organization? add the person who you have contacted about volunteering.

Volunteer Organization Contact Email*

Please include the email of the employee you worked with at the volunteer organization.

Participation Date*

What date will you volunteer with this organization?

Volunteer Hours*

What hours will you volunteer? (If it was during your work day, round to the nearest quarter hour, 15 minutes, e.g., 1:00-2:15)

After your volunteer opportunity*

Check the boxes below indicating that you will complete the two follow-up tasks.

Complete the form confirming your hours that you volunteered (HINT: you will receive this in your work email.)

Let your contact person know they will receive a form in their email confirming your experience and feedback on our program.

You are just about done!

The last two questions ask about your leave request and an acknowledgement.

Leave Request*

You must submit your VLO leave request and have supervisor approval before participating.

Yes, I have submitted my VLO leave request

No, I plan to submit within 24 hours of completing this form

Other, I do not know how to submit for VLO leave

No worries, we can help

Use the same process you normally use to request sick or discretionary leave. Just select Voluntary Leave Opportunity (VLO).

Acknowledgement*

I understand this opportunity is strictly voluntary and that Worker's Compensation does not cover expenses related to injuries incurred during the volunteer opportunity.

Yes, I am responsible for any injury expenses related to this volunteer opportunity.

Done!

Don't forget to check the box indicating that you want a copy of your responses. (Right below.)

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