Fillable G-1242 Form RE 9-15-11

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G-1242 Form RE 9-15-11

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Form G-1242 (Rev. 09/15/11) Page 1 of 2
Form G-1242, Volunteer Employment Program
Agreement With Academic Institution
Department of Homeland Security
U.S. Citizenship and Immigration Services (USCIS)
Student's Full Name (print):
Position Title, Series, & Grade:
Program Office:
Expected Completion of Educational and Work Requirements (mm/dd/yyyy):
Educational Institution & Program:
Appointment's Not-To-Exceed Date (mm/dd/yyyy):
Telephone Number:
Supervisor's Name (print):
USCIS
Form G-1242
General Student Eligibility
1. Be sixteen (16) years of age.
2. Be a citizen of the U.S.
3. Be enrolled, at least half-time, in an accredited high school or pursuing a degree, diploma, certificate, etc. in a technical or
vocational school, 2-year or 4-year college or university, graduate or professional school or participate in an accredited or State-
certified home-school (high school students only).
4. Maintain good academic standing of at least a “C” average 2.0 out of 4.0 grade point average (GPA).
5. Meet the security requirements for the position.
6. Provide a signed formal agreement.
This agreement constitutes a mutual understanding between the U.S. Citizenship and Immigration Services (USCIS) and the above
named institution, for the purpose of placing the above named student, in a volunteer, non-paid work assignment as part of a program
established to provide educationally-related work experience for the student.
Both parties agree that:
1. The student named above is officially enrolled in a course of study at the above-named institution;
2. The above-named institution has given permission for the above-named student to volunteer his/her services;
3. The services to be rendered are to be uncompensated, i.e., non-paid volunteer service; and
4. The participating student is not considered to be a Federal employee for any purpose other than for:
a. Federal Tort Claims provision published in 28 U.S.C. 2671 through 2680. Claims arising as a result of student participation
should be referred to the USCIS; and
b. 5 U.S.C. 8101 through 8193, relative to compensation for injuries sustained during the performance of work assignments.
Claims related to injuries should be referred to the Office of Workers' Compensation Programs, U.S. Department of Labor
for adjudication.
Form G-1242 (Rev. 09/15/11) Page 2 of 2
USCIS HQ Student Employment Programs Manager:
Date (mm/dd/yyyy)Signature Print Name
School Representative:
Date (mm/dd/yyyy)Signature Print Name
WAIVER OF COMPENSATION
*Failure to complete this agreement will result in termination.
Supervisor:
Date (mm/dd/yyyy)Signature Print Name
In connection with my services as a student volunteer in USCIS, I understand that I will be working during the period shown above
without compensation and I hereby agree to waive any and all claims against the Government for salary or wages for services
performed.
The USCIS will maintain an attendance record showing the dates and hours of the student's attendance on the job. In addition, the
USCIS will provide the above-named institution with a supervisory appraisal of the student's performance that meets the academic
crediting requirements of the institution, if any, upon completion of the volunteer service period.
Student:
Date (mm/dd/yyyy)Signature Print Name
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G-1242 Form RE 9-15-11

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Completed 20 February 2020

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