Touchstone Services Inc.
"Our goal is simple...To help you reach yours"
It the policy of Touchstone Services, Inc. to encourage volunteers to work in the program and with members. Each volunteer working in the program must certify in writing that he or she is free from communicable disease and the volunteer’s physical and mental health will not negatively affect either the health of the members or the quality of the members’ treatment before volunteering in the program.
A volunteer under the direction of Touchstone Services, Inc. shall sign a statement indicating whether he or she is on court-supervised probation or parole or has been convicted of a crime. The agency may also require a criminal history check. The volunteer under the direction of the agency shall be in such physical and mental health so as not to negatively affect either the health of the members or quality of his or her treatment and must be suitable to assure the welfare of the members.
A volunteer under the discretion of the agency will be required to review and familiarize himself or herself with the policies and procedures of Touchstone Services, Inc., with particular attention to Recipient Rights and Confidentiality. The volunteer’s name, address and telephone number must be submitted to the program.
A Functional Job Task List will be developed for each volunteer / student by the designated supervisor.
In the case of professional student volunteers, the Administrative Team will assign privileges and determine what services can be provided based on qualifications. Access to case files will be based on need as determined by the Program Director and in accordance with agency policies and applicable laws.
Volunteers and students are expected to present themselves to members and the community as such and not as regular employees. They must also abide by the wishes of members if the individual does not wish to participate with the student.
Volunteers are covered under the Agency’s comprehensive liability insurance policy. Students and volunteers are not covered under the agency’s personal injury, Worker’s Compensation or other insurance.
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TOUCHSTONE SERVICES, INC.
Address: _____________________________________
Telephone Number: _____________________________
Social Security Number: __________________________
Type of Placement: Student _____ Volunteer _____
College: __________________________________
Discipline: ______________________ Field Instructor: ___________
Placement Advisor: _________________________
Placement Began: __________________________
Placement Ends: ___________________________
Touchstone staff supervising Placement: __________________________
TOUCHSTONE SERVICES, INC.
VOLUNTEER / STUDENT INFORMATION AUTHORIZATION FORM
1. Proper insurance coverage is needed for an automobile driven in the State of Michigan. You, as a student/volunteer have the responsibility to be sure that the automobile you may use for the program(s) has adequate insurance. No special additional insurance is required for your car, but you need to have the basic automobile coverage required for any vehicle.
2. As a student / volunteer, you will be expected to abide by the policies of Touchstone Services, Inc., standards and rules, especially regarding confidentiality and Recipient Rights. This information will be provided to you and described by the staff.
3. Whenever the public is served, the possibility for legal liability must be considered. Hopefully, this type of difficulty will never occur in this program(s). I will provide a copy of my Professional Liability Insurance coverage. In the case it is needed, all students / volunteers in the program(s) are covered under Touchstone Services, Inc.’s professional liability insurance policy. This does not cover personal injury, worker’s compensation or other insurance.
4. I agree not to represent myself to members, staff or the public as a Touchstone staff, but to represent myself as a student / volunteer.
5. I agree to hold forth all ethical standards of my position with the agency. I have read the above and understand all provisions. I understand my responsibilities in these areas. I agree to maintain reliable transportation during this placement. I also give the program(s) authorization for a check of my driving record by the Michigan State Police driver records. I also give permission for the agency to obtain a background check. This authorization is valid only during the period I am a student / volunteer for the program(s).
6. I understand that my placement within the agency is on a “volunteer” basis, thus, without compensation or benefits provided to employees. As such, the placement may be terminated by either the agency or myself with or without cause. Such notification if effective upon mailing a written notice.
7. I understand that I may be required to attend new orientation/training sessions.
______________________________ ____________________
TOUCHSTONE SERVICES, INC.
STUDENT EVALUATION
Educational Program: _______________________
Placement Site: ___________________ Supervisor: ________________
Placement Began: ________________ Placement Ends: ____________
1. Describe how the student utilized knowledge they learned in the classroom and applied it to practice in their placement.
2. Describe the specific responsibilities / duties performed by the student.
3. Describe the service population the student worked with and the type of intervention techniques they used.
4. Did the student complete the appropriate number of hours to meet their placement requirements? If not, why?
5. Overall Evaluation:
Supervisor: ____________________________________ Date: ______________