Appendix A
March 2016
To avoid a delay in processing, application must be filled out in its entirety.
For the security and safety of volunteers, offenders, and employees, criminal histories of applicants are reviewed and may require fingerprinting
in some instances. Volunteer applicants with previous felony convictions are not necessarily excluded from participation. All applications will be
reviewed and will receive a response.
When answering the following questions, do not include any violation of the law committed before your 17th birthday if the final decision was made
in juvenile court or under a youth offender law; any conviction record that was expunged under federal or state law; or minor traffic violations.
All other convictions must be included.
1. Have you ever served time in any adult correctional facility? Yes No
If yes, please provide the following:
Years served: State: ID #: Release date: / /
2. Are you currently an active member of a gang? _____________________________________ Yes No
3. Have you ever been a member of a gang? If yes, name and description of gang: _________ Yes No
Beginning date / / ending date: / /
4. Do you have any criminal charges currently pending? Yes No
If yes, please explain:
5. Are you now or have you ever been placed on probation or parole? Yes No
If yes, beginning date / / ending date: / /
*If you are currently on community supervision (parole or probation), a statement from your supervising
officer indicating they are aware that you are applying to volunteer with the TDCJ and that you are
meeting the requirements of your supervision must be submitted to Volunteer Services on original
letterhead, signed and dated (see address below).
6. Have you ever forfeited property/bond as a result of being charged with any criminal act? Yes No
If yes, please explain:
7. Do you have a maiden name, alias, or nickname? If yes, provide: Yes No
8. Have you ever been convicted* of a crime? Felony Misdemeanor Yes No
*Convicted includes deferred adjudication, community supervision and those that may not appear on record at this time, but exc
minor traffic violations. If yes, provide the information below. All convictions apply. Attach additional pages as needed.
When: Where:
Charges: Disposition:
(Result of charge, i.e., community service, paid fine, served time)
Signature _________________________________________________ Date / /
Month Day Year
Submit Application
You are encouraged to complete the application and submit at a TDCJ Volunteer Training session, if there is not a training
session available at this time fax or mail the application as instructed below.
See training schedule for dates and locations
HANDWRITTEN:
For legibility reasons, please do not fax a handwritten application. Please mail the completed
application to: Volunteer Services, 2 Financial Plaza, Suite 472, Huntsville, Texas 77340.
TYPED:
Please print and fax the completed application to: (936) 437-2852, ATTN: Merline Kellum.
For security reasons, please do NOT send this form via e-mail attachment.
Notice: With few exceptions, you are entitled upon request: (1) to be informed about the information the Texas Department of Criminal Justice (the Agency) collects about you; and
(2) under Texas Government Code §§552.021 and 552.023, to receive and review the collected information. Under Texas Government Code §559.004, you are also entitled to request,
in accordance with the Agency’s procedures, that incorrect information the Agency has collected about you be corrected.
