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Form preview How to fil volunteer service a... DO NOT keep a copy of the document for his/her file. Optional Form 301a 09/2010 USDA-USDI I understand that I will not receive any compensation for the above service and that volunteers are NOT considered Federal employees for any purpose other than tort claims and injury compensation. I understand that volunteer service is not creditable for leave accrual or any other employee benefits. I also understand that either the government or I may cancel this agreement at any time by notifying the other party. OMB 0596-0080 Expires 12/2013 Volunteer Services Agreement for Natural Resources Agencies for Individuals or Groups- Please complete Green boxes Please print when completing this form Name of Volunteer or Group Leader Last First Middle Agency-Site Name/Project Leader Not Applicable U.S. Forest Service at Midewin/ See Attachments Age Under 18 18-25 26-55 56 and Older Group Name if applicable Are you a U.S. Citizen Yes No Visa Type Reimbursement if any Preferred Phone Email Address Cell Home Work Street Address City State Zip IF VOLUNTEER IS UNDER AGE 18 Name of Parent/ Legal Guardian Home Phone Mobile Phone I affirm that I am the parent/guardian of the above named volunteer. I understand that the agency volunteer program does not provide compensation except as otherwise provided by law and that the service will not confer on the volunteer the status of a Federal employee. I have read the attached description of the service that the volunteer will perform* I give my permission for to participate in the specified volunteer activity sponsored by at Name of Group if applicable From Midewin National Tallgrass Prairie to Date Parent/Guardian Signature Emergency Contact Name Phone GOVERNMENT OFFICIAL COMPLETES THIS SECTION If you are a group leader please attach a roster or list participants names in this box. Government Vehicle required Personal Vehicle to be used No Valid State Driver s License International Driver s License Please verify that the volunteer is in possession of one of these documents. DO NOT keep a copy of the document for his/her file. Optional Form 301a 09/2010 USDA-USDI I understand that I will not receive any compensation for the above service and that volunteers are NOT considered Federal employees for any purpose other than tort claims and injury compensation* I understand that volunteer service is not creditable for leave accrual or any other employee benefits. I also understand that either the government or I may cancel this agreement at any time by notifying the other party. me to perform my duties. specifically stated in the attached job description will become the property of the United States and as such will be in the public domain and not subject to copyright laws. project location and certify that the statement I have checked below is true No medical condition or physical limitation that may adversely affect my ability to provide this service. I do know of a medical condition or physical limitation that may adversely affect my ability to provide this service and have explained it to.

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