Youth Center Volunteer Application

Volunteer Application
I. Applicant Information for ICHAT

The information collected in the Applicant Information section will be used for the purposes of performing a criminal background check through the Michigan State Police Internet Criminal History Access Tool (ICHAT).
Program *
E-mail
First Name *
Middle Name
Last Name *
Suffix
Date of Birth *

Month Day Year
Date
Race *
Gender *
If you have lived outside of the state of Michigan within the past 5 years, you must include all of your previous addresses below.

Youth Center staff will be in contact with you to complete additional paperwork for out of state criminal history and central registry clearances.

Failure to report previous out of state addresses will result in the termination of your volunteer services at the Youth Center.
Have you lived outside of the state of Michigan in the past 5 years? *

Yes No
Please list all states outside of Michigan that you have lived in during the past 5 years.
Please scan or take a clear photo of your Driver's License and attach it below. Your application will not be processed without a copy of your photo ID.
Digital copy of Identification *
Usage Agreement *

I accept and understand that the information I have provided in this application will be used for the purposes of performing a criminal background check via the Michigan State Police ICHAT. A background check will be performed prior to beginning my services as a volunteer and again annually if I continue to volunteer for a period of more than 12 months. I have the right to revoke my volunteer application and permission to run additional background checks at any time, which would result in the termination of my services as a volunteer.

II. Central Registry Clearance Request

All volunteers must be cleared through both the ICHAT and MDHHS via a Central Registry Clearance.

Please download a copy of the Central Registry Clearance Request form using the above link and complete section 1. After completing section 1 of the form, you must print and sign the document and then scan and upload it using the file upload button below.

If you are unable to scan and upload the document you may also turn it in to the Youth Center directly at 4125 Washtenaw Ave. Ann Arbor, MI 48108.
Central Registry Clearance Request Form

III. Volunteer Code of Ethics

If accepted as a volunteer, you shall:
- Keep matters confidential (additional details on next page).
- Interpret "volunteer" to mean you have agreed to work without financial compensation, but having been accepted as avolunteer worker, are expected to work according to the same standard as paid staff.
- Maintain an attitude of open-mindedness and a willingness to receive training and feedback.
- Complement staff efforts and assist in developing and maintaing good teamwork.
- Maintain a professional attitude toward volunteer work, accept obligation to the work, to those who direct it, to colleagues, to those for whom it is done, and to the public.
- Follow all procedures detailed in Washtenaw County Youth Center Policy 1.11: Monitoring and Reporting Abuse & Neglect:
  
  To ensure the safety of the youths in the Youth Center, all suspected incidents of child abuse or neglect, whether they occurred prior to admission or during the youth’s stay, shall be reported immediately to the statutorily designated authority. The Youth Center Director shall initiate a thorough investigation and administer appropriate disciplinary actions and/or criminal prosecution.
- Follow all procedures detailed in Washtenaw County Youth Center: Policy 3.2 Code of Ethics:
  
  The Washtenaw County Youth Center has adopted a Code of Ethics based on the American Correctional Association’s Code of Ethics and the National Association of Social Workers’ (NASW) Code of Ethics for all employees and volunteers. No staff person of the Center shall use their official position to secure privileges for themselves, engage in behavior which could bring discredit to the Center, engage in activities inconsistent with the Center’s mission or violate any individual’s constitutionally guaranteed rights.
- Follow all procedures detailed in Washtenaw County Youth Center Policy 3.8: Professional Boundaries, Employee Relationships with Consumers: All employees and volunteers of the Washtenaw County Youth Center are required to maintain professional boundaries with consumers. This policy sets forth guidelines addressing professional boundaries of employee specific to employee/consumer interactions and relationships.
- Follow all procedures detailed in Washtenaw County Youth Center Policy 3.13: Sexual Orientation and Gender Identity:
  
  In accordance with state and federal laws, each youth under the jurisdiction of the Washtenaw County Youth Center (WCYC) shall have the right to live in an environment free of harassment and discrimination. WCYC shall be committed to providing a healthy and accepting setting for youths placed in the care of the WCYC. WCYC staff shall respect the dignity of lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI) juveniles and create an environment that is safe and free of discrimination.
- Follow all procedures detailed in Washtenaw County Youth center Policy 12.1: Legal Rights of Youth While Placed in Detention:
  
  All youth shall be protected from discrimination based on race, national origin, color, creed, age, gender, gender expression, sexual orientation, height, weight, physical handicap, and political and/or religious beliefs. All youth shall not be restricted from access to programs and activities based on these protected characteristics. All youth shall be assured that seeking judicial relief will not be met with reprisal or penalty. All youth have the right to legal representation.
Code of Ethics Agreement *

I acknowledge that I have read, understand, and agree to abide by the Washtenaw County Children's Service Volunteer Code of Ethics.

IV. Confidentiality Agreement and Policy

Confidentiality is maintained for all knowledge and information as described in the Confidentiality Agreement. To ensure confidentiality, all volunteers are required to review, confirm, and sign the Confidentiality Agreement.

Confidentiality Agreement

As a volunteer of Washtenaw County Children’s Services (WCCS), I may be provided with confidential information (including identity and image of youth in custody) regarding the court involved youth. As a volunteer, I may have privileges to know confidential information about children and their families that are receiving services from Washtenaw County Children’s Services. Confidential Information may include, but is not limited to: Name, gender, ethnicity, citizenship, and disability status.

Policy

Volunteer must review, confirm, and sign the Confidentiality Agreement. As a volunteer I agree to:
- Respect the confidentiality rights of every child who resides in this childcaring institution.
- Not capture or record any image of youths during video sessions (conference call is only for the audience of the volunteer).
- Not disclose confidential information without proper authorization (WCCS Administration) or other than when it is necessary to carry out volunteer duties.
- Not access, report on, extract, or disclose information that is not required in their normal volunteer functions and responsibilities.
- Not discuss or otherwise communicate any form of information concerning the care or condition of any child with unauthorized individuals.
- That confidentiality applies equally to verbal information and information stored in information systems (databases) and on paper records. Written or printed information will be stored in a secure place and/or disposed of with proper regard for Confidentiality, following all legal requirements related to the information in question.
- Failure to abide by the child confidentiality requirements may result in termination of volunteer services and/or legal action.
Violations or suspected violations of the Confidentiality Agreement should be reported immediately. Reports from customers, providers, or community members are handled by Washtenaw County Children’s Services Administration.
Signature *

Clear
Date *

Month Day Year
Date
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Form Link
PDF Link for Printing
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