print out the following forms, fill out and obtain all required
signatures. Return to LHU HR Dept.
is recognized that individuals may desire to participate as
volunteers/interns in Lock Haven University activities solely for their
own personal purpose or pleasure without the expectation of promise or
compensation. These individuals become in no sense employees of Lock Haven
University. While the use of
such volunteers/interns is permissible, it should be understood that
adherence to the below stated procedures is absolutely necessary in order
to avoid conflicts of interest, violations of the law or labor contracts,
and mismanagement of University funds or facilities.
All applications for volunteer/internship service must be reviewed
and approved. Appropriate coordination should occur with labor
organizations. Approval will be given through a letter of acknowledgment
signed by the appointing authority.
Any changes in the nature or extent of previously approved
volunteer/internship services must be made by the appointing authority.
All records relating to volunteer/internship services must be
maintained by the using authority for at least 6 years after the date the
All orientation, training, and supervision of volunteers/interns
will be the responsibility of the appointing authority.
Haven University provides limited insurance coverage for authorized
volunteers/interns who are accidentally injured or become ill as a direct
result of providing volunteer/internship services to Lock Haven
University. This insurance is not workers compensation insurance but it is
administered through Lock Haven University's worker's compensation
carrier. Consequently it DOES NOT include any disability or
catastrophic loss income for volunteers/interns or their survivors.
Coverage is limited to MEDICAL and HOSPITAL BENEFITS ONLY
and will be subject to criteria and procedures contained in the workers'
compensation program administrative rules. In addition, damage or loss
sustained to personal property; for example, clothing, eyeglasses,
vehicles, etc., IS NOT covered.
Date of Birth _____________________________________
Emergency Address Information:
Purpose of Volunteer/Internship Services (To be completed by volunteer/intern):
Expected Duration of Volunteer/Intern Services:
Dates - From _______________________________ To ________________________
I understand that I will receive no compensation,
monetary or otherwise from the University, and that no promises are being
made by the University relative to the donation of my services as a
volunteer/intern. I also
agree to comply with all rules and regulations governing the University
community. Finally, I
understand that my volunteer/internship services may be terminated at any
time by the University and that I have no rights or claims arising as a
result of such termination or previous services rendered.
I have read and agree with all statements made by the
volunteer/intern and will adhere to applicable institutional procedures
regarding volunteer/internship service.
Director/ Dean _______________________________________ Date _____________
Approved Vice President ________________________________ Date _____________
Approved Director of
As of 09/02/2004