Form HR 1.80 (9/92)
The University of North
Carolina at Wilmington
STATEMENT OF VOLUNTARY SERVICE
Volunteer Name: ________________________________________________________
Address: ________________________________________________________
________________________________________________________
Telephone: ________________________________________________________
Department Where Voluntary Services Will be Provided: ______________________________
Description of Voluntary Services: _______________________________________________
____________________________________________________________________
____________________________________________________________________
Expected Duration of Voluntary Service:
From: __________________ To:
_______________________
My signature below indicates that I have
volunteered to perform the duties described above for the University of
North Carolina at Wilmington. I acknowledge that, as a volunteer, my services
are provided without promise or expectation of compensation or other material
benefits. I undertake these voluntary services at my own risk and acknowledge
that I am not covered by workers' compensation or university-sponsored
health insurance.
________________________________ __________________________________
Individual
Volunteering Services UNCW
Official
Accepting
Voluntary Services
________________________________ ___________________________________
Date
Date
Forward completed form to Human Resources