Randolph Community College
Creating Opportunities. Changing Lives.
RCC Volunteer Data Information Sheet
Name: ______________________________________________________________________
First Middle Last
Preferred Name: _____________________________________________________________
(Nickname, etc.)
Address: ____________________________________________________________________
City, State, Zip: ______________________________________________________________
Telephone Number: ___________________________________________________________
Email Address: ______________________________________________________________
Emergency Contact: __________________________________________________________
Relationship: ________________________ Phone Number: _________________________
Brief Description of Volunteer Services:
Have you ever been convicted of an offense against the law other than a minor traffic
violation? No Yes (If yes, explain fully on the back of this form.)
(A charge/conviction does not mean you cannot volunteer. The offense and how recently you
were convicted will be evaluated in relation to the volunteer activities.)
I certify that all of the statements made on this document and any attached documents are true,
complete, and correct to the best of my knowledge and belief and are made in good faith.
Volunteer Signature: ___________________________________________________________
Name & Title of RCC Contact/Supervisor: _________________________________________
(Please print)
Approval of Vice President: _____________________________________________________
Signature Date
*Please note that the following forms are required for all volunteers:
• Volunteer Data Information Sheet • Volunteer Agreement
