Food Stamp Enrollment Volunteer Agreement/Notice of Privacy Practices

Your work as a volunteer with the Food Stamp Enrollment Program provides a vital service to low-income residents of New Jersey and crucial support for the Learning to End Hunger Campaign’s mission to end hunger in New Jersey. Thank you for your work and commitment.

Please read, sign, and return this volunteer agreement before beginning your service. Please initial each section to indicate that you have read and understand your responsibilities.

The Learning to End Hunger Campaign Supervisors agree:

  1. To provide you, as a volunteer, with a mutually agreeable site(s) at which you will conduct food stamp pre-screenings and provide assistance with nutritional handouts and follow-up support.
  2. To provide training and support by a Food Stamp Enrollment Coordinator, who will answer your questions, provide feedback and offer continuing support throughout your service.
  3. To recognize your contributions as a volunteer to the success of Learning to End Hunger’s work.
  4. To make an effort to address any concerns or problems that might come to your attention.

As a volunteer, I agree:

  1. To fulfill my weekly commitment by visiting my assigned site, pre-screening individuals for food stamp eligibility, and conducting promotional food stamp drives, creating informational handouts, and making follow-up advocacy calls to clients.
  2. To contact the Food Stamp Enrollment Coordinators immediately if I am unable to attend my site.
  3. To record my hours as a volunteer on a Volunteer Time Sheet and mail them, along with all client logs and records containing any client information, to the Food Stamp Enrollment Coordinator within 24 hours.
  4. To consistently and indiscriminately conduct outreach in the waiting room of my assigned site.
  5. I will treat the members that I serve with sensitivity and respect.
  6. I will contact my food stamp enrollment coordinator and/or staff from the field if any questions regarding screenings and applications arise.
  7. To dress appropriately and always wear my name badge.
  8. I understand that if I fail to attend one on-site training or two regular service sessions without notifying my Food Stamp Enrollment Coordinator at least 24 hours in advance, I will not be allowed to continue service as a volunteer.

Confidentiality:

  1. I will never share sensitive client information including, but not limited to, names, social security numbers, birthdates, contact information, income.
  2. I will keep any paper or electronic records containing client information private and in my possession or in the possession of my Food Stamp Enrollment Coordinator at all times.
  3. I will not access, use, or disclose any client information unless required to do so in the official capacity of my position as a food stamp volunteer.

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Volunteer Name Date

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Volunteer Signature

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Food Stamp Enrollment Coordinator

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