Restorative Justice Community Member Interest Form

Name (First and Last)*

Preferred name

Pronouns

Phone Number*

Email Address*

What best describes your role in the community?*

Student
Staff
Faculty
Alum
Local resident
Business owner
Other

What year are you in school?

First Year
Sophomore
Junior
Senior
Graduate

Please indicate which of the following you most identify with:

Title/Name of Department

Gender

Hobbies/interests:*

Other than English, what languages do you speak fluently?

Please share why you are interested in volunteering with the Restorative Justice program.*

What, if any, prior experience do you have with Restorative Justice?*

Are there specific types of cases/incidents you are particularly interested in?

Please share anything else you would like us to know about you.

Please review and indicate your acknowledgment of the following terms which we require volunteers to agree to:*

Confidentiality: If accepted as a volunteer for the SRC Restorative Justice Program, I understand I may be privy to confidential information and agree to maintain the confidentiality of such information whenever presented with it.

Permission to use image/testimonial data: I give the Student Resolution Center (its employees, designees, agents, independent contractors, legal representatives, successors and assigns, and all persons or departments for whom or through whom it is acting) the absolute right and unrestricted permission to use my name, testimonials, biographical data, as well as any photographic images (still or moving) of my participation in Student Resolution Center related activities/events, for and/all of the following purposes: art, advertising, recruitment, marketing, fund raising, publicity, archival, any other lawful purpose. I waive any right that I may have to inspect and approve the finished product that may be used, and I waive any right to royalties or other compensation arising from or related to the use of the image or product. I release and agree to hold harmless the Student Resolution Center (employees, agents, volunteers, and/or others for whom or by whom the Student Resolution Center is acting) of and from any liability by virtue of taking, processing, or utilizing the photographic images of me and my testimonial/biographical data.

I promise to take due care during my volunteer activities and am aware of the hazards and risks that may be associated with my participation in restorative justice. I understand, accept, and assume all such hazards and risks and waive all claims against the Student Resolution Center, its staff and volunteers for any injuries suffered by me or damages to my property arising out of or related to my participation in volunteer activities with the SRC.

Terms of Volunteering: I understand that in order to ensure quality service, the Student Resolution Center maintains all authority over who volunteers, and that at any time I may be dismissed as a volunteer.

Certification: I certify that I am at least 18 years of age and that this release is signed voluntarily, under no duress, and without expectation of compensation in any form now or in the future. I confirm the information I have provided is correct.

I agree to these terms

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Name

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