Your Details

First Name(s):		Surname:
Gender:		Please Choose....MaleFemaleOther
University SID Number:
Year of Study:		Please Choose...Foundation1234Post GraduateAlumniStaff
Are you:		...UKEuropean UnionInternational
Type of Study:		...Full TimePart time
Nationality:
What languages do you speak?
Faculty:		...Art & DesignBusiness, Environment & SocietyEngineering & ComputingHealth & Life SciencesLifelong Learning
University Course Title:
Course End Date:
Telephone Number:
Mobile Number:
Email:

Current Volunteering

Additional needs or requirements

Consent for the use of personal data 

Under the terms of the Data Protection Act 1998, your consent must be obtained before we can use your image or personal details in any promotional materials. We may also publish your image and personal details on our web pages. You should be aware that this means that information about you is available worldwide, including in countries where there is no data protection legislation.

I agreedon't agree * to let my personal details be used in the way described above.
(*Please choose appropriate) 

I certify that the information is to the best of my knowledge, true and accurate. If any of the information given in this form is not true, I recognise that any offer of a voluntary placement may be withdrawn.
  

I am aware that any information I provide to CUSU Volunteering & Employability will be passed onto organisations that I am interested in volunteering with. I am also aware that the information I provide along with the details of any volunteering I take part in may be used by Coventry University for statistical purposes.
 

Please read the Volunteer Agreement below and make sure you understand it before submitting this form. If you have any questions please see a member of staff at CUSU Volunteering & Employability.

 

Please tick if you do not want to receive general Students' Union news by email:

Volunteer Agreement

Please make sure that you have read and fully understood this agreement, before starting any voluntary placement.

As a volunteer you have the right to:

• Receive adequate induction, training, support, guidance and supervision.
• Have a clear description of your role as a volunteer.
• Give the required amount of time for the volunteering role.
• Have any concerns dealt with.
• Change volunteering hours through negotiation.
• An introduction to relevant policies which apply to you.
• Be treated according to equal opportunities and confidentiality policies.
• Feel safe and respected.
• Only carry out tasks you have agreed to and feel comfortable doing.
• Be provided with everything you need to complete your volunteering safely and effectively.
• Claim expenses (please note availability of expenses is limited).
• Be properly recognised for your volunteer work in the form of relevant certification and celebration.

As a volunteer you have the responsibility to:

• Be reliable and punctual whilst on placement.
• Attend all agreed support and training sessions.
• Report any changes in circumstance to your supervisor at the organisation. E.g. if you are going to be   late, or need to make changes to your commitment.
• Inform Volunteering and Employability and your supervisor at the organisation of any changes to your contact details.
• Attend your placement at agreed times and tell the project supervisor in advance if this is not possible.
• Let your supervisor at the organisation and Volunteering and Employability know if you no longer want to volunteer and wish to cancel your placement.
• Inform your placement supervisor and Volunteering and Employability if you have any problems, issues or concerns.
• Behave in a manner that represents Coventry University and Volunteering and Employability in the best possible light.
• Abide by the policies, procedures and standards of the placement organisation.
• Observe all health and safety requirements as directed and act responsibly with regard to your own health and safety and that of others around you.
• Provide Volunteering and Employability with feedback when requested (usually at the end of the academic year) to allow us to develop and improve our service.
• Return the Placement Agreement, Induction Checklist and Volunteering Time Sheet.
 

Equal Opportunities Monitoring Form - Confidential

We are collecting this data in order to monitor our progress towards equal opportunities and diversity as specified in our Volunteer Guide. Any personal information that you provide below will be used solely for monitoring purposes and will not be reproduced in any way that enables individuals to be identified.

Please tick if you would rather not answer the questions below:

Age: ...18-2122-2526-3536-4950-Over

Ethnic Origin: ...White - BritishWhite - IrishWhite - OtherBlack or Black British CaribbeanBlack or Black British AfricanOther Black BackgroundAsian or Asian British-IndianAsian or Asian British-PakistaniAsian or Asian British-BangladeshiChineseOther Asian backgroundMixed - White & Black CaribbeanMixed - White & Black AfricanMixed - White & AsianOther mixed backgroundOther

Do you consider yourself to have any disability / impairment?: NoYes

If 'yes' how would you describe your disability / impairment?:...Visual ImpairmentHearing ImpairmentMobility impairmentMental Health concernSpecific Learning difficulty - i.e DyslexiaUnseen impairment - i.e Diabetes, asthmaOther impairment