Volunteering Information and Activity Form

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As the saying goes, volunteers are not paid because they are worthless, but because they are
priceless. The selfless acts you perform as a volunteer will have a lifelong effect you as the volunteer
and on the recipients. The faculty hopes this is a stepping-stone to continuing to be involved with your
community after graduation in your new career as a registered nurse.

By participating in volunteer events, you agree to follow these guidelines.

1. Pre-approved Activities
Announcements and sign-ups for pre-approved activities will be posted on the volunteer bulletin board in
the Skills Lab via D2L or my.vcccd email. Skills allowed to be performed, required attire, and the required
tools for the event will also be posted.
A. Read the announcement thoroughly. Sign-up after you have confirmed with your own schedule that
you are available and qualified for the event. Some events are restricted to certain class levels due to
the skill level required at the event.
B. Arrive at the event on time, in the prescribed attire and with the required tools. Bring a Volunteer
Activity Form and fill it out.
D. Have the person in charge of your activities at the event sign-off on your Activity Form.
E. As soon as possible after the event, bring the completed Activity Form to faculty Volunteer Coordinator
for final sign-off.
F. Keep a copy of the completed and signed form.
2. Individual Activities
A list of potential individual activities is posted on the volunteer bulletin board. Other individual activities must
be reviewed and approved by the faculty Volunteer Coordinator and nursing faculty as a whole.
A. Meet with the faculty Volunteer Coordinator and request an Independent Volunteer Activities Approval
Slip.
B. After discussing the event, obtaining approval, and filling out the Approval Slip, you may participate in
the independent activity for volunteer credit.
C. Arrive at the event on time, in the prescribed attire and with the required tools. Bring a Volunteer
Activity Form and fill it out.
D. Have the person in charge of your activities at the event sign-off on your Activity Form.
E. As soon as possible after the event, bring the completed Activity Form to faculty Volunteer Coordinator
for final sign-off.
F. Keep a copy of the completed and signed form.
3. Penalties

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By participating, you represent Moorpark College, the Moorpark College Nursing Program, and the nursing
profession. You are expected to act in a professional manner. This includes professionalism in punctuality,
appearance, communication, action, and behavior.
Complaints received by event or activity personnel regarding unprofessional conduct may result in negative
hours and a Performance Improvement Contract. Negative hours will be tracked by the Activities Coordinator.
Performance Improvement Contracts may restrict future event and activity involvement until behavioral and/or
skill remediation is performed.
The nursing faculty reserve the right to decide that a volunteer may not participate in future events.
A. If you discover you are unable to participate for the event you signed up for and it is within 5 days of
the event, you must replace yourself with a qualified volunteer.
- a no-show, no-replacement situation will result in negative hours and potentially a
performance improvement contract.
B. Falsifying any Activity Form will result in negative hours and a Performance Improvement Contract.
C. Failing to secure approval for an independent activity prior to participating will disallow those hours
from being credited.
D. Performing nursing skills without Moorpark College faculty supervision will result in all of the
following:
* Negative hours
* Performance Improvement Contract
* Review by the Moorpark College nursing faculty
* Possible discipline by the Moorpark College Nursing Program
* If required by law, reporting to the appropriate public authorities regarding the practice of
nursing without a license.
4. Extra Credit
At the end of each semester, you may have the opportunity to earn extra credit for having participated in
volunteering during that semester.
Only hours performed during the semester may be considered for possible extra credit points.
Awarding of extra credit points for volunteering is at the discretion of your faculty team.
Refer to the Moorpark College Associate Degree Nursing Handbook and semester workbooks details on the
amount of extra credit points available and restrictions on activities accepted.
5. Recognition
The Moorpark College nursing program recognizes participation performed during students nursing education.
Recognition is bestowed to the graduate during the Nursing Pinning Ceremony.
A. You will have kept your Activity Forms throughout each semester. Use the attached form to log each
activitys hours at the end of your final semester.
B. Turn in copies of your Activity Forms and your Log to your class volunteer representative on the date
announced.
6. Changes in policy and procedure.
The nursing faculty reserves the right to update and change these guidelines at any time. Changes will be
posted on the volunteer bulletin board.

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Volunteer Activity Form

Student:____________________________________Semester:

Volunteer Event :___________________________ Event Date:_____________

Location:____________________________________From:______ to_________
Volunteers hours*: ________________
Faculty Volunteer Activities Liaison signature: ___________________

Date ______

For consistency: A co-signature from the volunteer activities liaison is required after the event. It is the
volunteers responsibility to obtain this signature in a timely fashion.

Activities performed:__________________________________________________________
___________________________________________________________________________
Student's Comment:_________________________________________________________
__________________________________________________________________________
Contact Person:_____________________________Phone:___________________
Advisor/Contact person's
Comment:_____________________________________________________________________
________________________________________________________
Contact Persons Signature:____________________________Date:_______________
(Required)
*To receive volunteer hours for an independent volunteer activity: Must first fill out an Independent
Volunteer Activities form (get one from Christina), AND have the line below signed.

Approved prior to event: ______________________________

Date:_______________

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Volunteer Hour Totals for Graduation Recognition

Submitted this completed form with your Volunteer Activity Form sheets on the announced
date.

Your Name: ______________________

Date Submitted: ____________

Event Name

Date of
Event

Semester
you were in

Hours
Earned

Grand
Total:
Recognition:
20 hrs = certificate
40 hours = certificate and pin
60 hours = certificate, pin, and token of
appreciation

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