VOLUNTEER AGREEMENT FOR
PRIVACY ACT STATEMENT
AUTHORITY: Section 1588 of Title 10, U.S. Code, and E.O. 9397.
PRINCIPAL PURPOSE(S): To document voluntary services provided by an individual, including the hours of service performed, and to
obtain agreement from the volunteer on the conditions for accepting the performance of voluntary service.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; however failure to complete the form may result in an inability to accept voluntary services or an inability to
document the type of voluntary services and hours performed.
PART I - GENERAL INFORMATION
5. WHERE SERVICE OCCURS4.
7. OF WEEK6. OCCURS
9. OF VOLUNTEER SERVICES
I expressly agree that my services are being provided as a volunteer and that I will not be an employee of the United States
Government or any instrumentality thereof, except for certain purposes relating to compensation for injuries occurring during the
performance of approved volunteer services, tort claims, the Privacy Act, criminal conflicts of interest, and defense of certain suits arising
out of legal malpractice. I expressly agree that I am neither entitled to nor expect any present or future salary, wages, or other benefits
for these voluntary services. service providers and agree to
participate in any training required by the installation or unit in order for me to perform the voluntary services that I am offering.
follow all rules and procedures of the installation or unit that apply to the voluntary services I will be providing.
1. VOLUNTEER (Last, First, Middle Initial)
a. SIGNATURE OF VOLUNTEER b. SIGNED (YYYYMMDD)
2. 3. BIRTH (YYYYMMDD)
11.a. TYPED NAME OF ACCEPTING OFFICIAL
(Last, First, Middle Initial)
b. c. DATE SIGNED (YYYYMMDD)
PART IV - TO BE COMPLETED AT END OF VOLUNTEER'S SERVICE BY VOLUNTEER SUPERVISOR
14. AMOUNT OF VOLUNTEER TIME DONATED
a. YEARS (2,087
hours=1 year)
b. c. DAYS d.
15. SIGNATURE 16. TERMINATION DATE
(YYYYMMDD)
17.a. TYPED NAME OF SUPERVISOR
(Last, First, Middle Initial)
b. c. DATE SIGNED (YYYYMMDD)
APPROPRIATED FUND ACTIVITIES NONAPPROPRIATED FUND INSTRUMENTALITIES
8.
10. CERTIFICATION
PART III - VOLUNTEER IN NONAPPROPRIATED FUND INSTRUMENTALITIES
I expressly agree that my services are being provided as a volunteer and that I will not be an employee of the United States
Government or any instrumentality thereof, except for certain purposes relating to compensation for injuries occurring during the
performance of approved volunteer services and liability for tort claims as specified in 10 U.S.C. Section 1588(d)(2). I expressly agree
that I am neither entitled to nor expect any present or future salary, wages, or other benefits for these voluntary services. I agree to be
bound by the laws and regulations applicable to voluntary service providers, and agree to participate in any training required by the
installation or unit in order for me to perform the voluntary services that I am offering. cedures of the
installation or unit that apply to the voluntary services
13.a. TYPED NAME OF ACCEPTING OFFICIAL
(Last, First, Middle Initial)
a. SIGNATURE OF VOLUNTEER b. SIGNED (YYYYMMDD)
12. CERTIFICATION
b. c. DATE SIGNED (YYYYMMDD)
PART II - VOLUNTEER IN APPROPRIATED FUND ACTIVITIES
ORGANIZATION/UNIT INSTALLATION
ANTICIPATED DAYS PROGRAM WHERE SERVICE
DESCRIPTION
I agree to be bound by the laws and regulations applicable to voluntary
I agree to
TYPED NAME OF
DATE
SSN DATE OF
SIGNATURE
WEEKS HOURS
SIGNATURE
ANTICIPATED HOURS
I agree to follow all rules and pro
that I am offering.
DATE
SIGNATURE
DD FORM 2793, FEB 2002
PREVIOUS EDITION IS OBSOLETE.
Exception to Standard Form 50 granted by
Office of Personnel Management (OPM) waiver.
