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U.S. DEPARTMENT OF JUSTICE |
Section I Assignment Data
1. Student's Name:
2. Academic Discipline, if applicable:
3. Educational Institution:
4. Academic Level:
5. Statement of Service to be Performed:
6. Assignment Location:
7. Proposed Length of Service:
8. Proposed Tour of Duty:
Section II Education Institution Agreement
I certify that (Name of student) is a student enrolled not less than half-time and is in good academic standing. The duties to be performed and scheduled hours of work are approved as appropriate for the course of study or training that he/she is pursuing. The student (will/will not) be given academic credit for the volunteer service.
I understand that a record of the student's attendance and an evaluation of his/her performance will be provided to this institution when the volunteer service is completed.
Signature of Approving Official Date
Title
Educational Institution
Section III Volunteer Student Agreement
I have read the above statement of service to be performed and agree to perform the assignment as described.
I understand that:
I am to receive no pay or other compensation for services rendered;
I hereby agree to waive any and all claims against the Government for salary or wages on account of services performed;
I am not considered to be a federal employee for any purpose other than for purposes of:
(a) the Federal Tort Claims provisions published in 28 U.S.C. 2671 through 2680. Claims arising as a result of student participation should be referred to the Department of Justice; and
(b) title 5, U.S.C. Chapter 81, relative to compensation for injuries sustained during the performance of work assignments. Claims related to injuries should be referred to the Office of Workers' Compensation Programs, U.S. Department of Labor, for adjudication.