**U.S. DEPARTMENT OF AGRICULTURE**

**STUDENT VOLUNTEER AGREEMENT**

This agreement covers the acceptance of volunteer service under 5 USC
3111, 7 USC 2272, and 5 CFR 308. It also serves as a record of student
volunteer service.

**Student Volunteer Name:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Home Address:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Telephone:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I understand that:

-   My services are on a volunteer basis without compensation or
    reimbursement for any incidental expenses.

-   I am not considered a Federal employee except for the purposes of
    the Federal Employees Compensation Act and the Federal Tort Claims
    Act and will not be eligible for health insurance, life insurance,
    retirement or any other benefits.

-   My service may not be credited for civil service retirement purposes
    if I am later employed by the government, though the work may count
    as experience for qualifications purposes.

-   I am permitted access to the work site only during my approved duty
    hours.

-   I am to conduct myself with honesty and integrity and observe all
    rules of safety in the performance of my duties.

-   Permission must be given by my supervisor before I operate any
    government equipment or motor vehicle or handle any property, that
    it may be used for approved, official purposes only, and that I may
    be held responsible for any unreasonable damage.

-   I am not authorized to represent the agency in any matter or
    proceeding nor expend government funds.

-   Any inventions made during the assignment must be submitted to the
    Agency/Staff Office for a determination of rights. Prior approval
    must be obtained prior to publishing the results of any work, study
    or research.

-   I serve under the supervision of a Federal official. A record of my
    attendance and evaluation of my performance will be provided to my
    educational institution and to me when the work assignment is
    completed.

-   This agreement may be terminated at any time by my educational
    institution, the Agency/Staff Office, or me.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(Student Volunteer Signature) (Date)**

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**(If under 18 years of age, Parent/Guardian Signature) (Date)**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(Responsible Educational Institution Signature) (Date)**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(Supervisor/ Signature) (Date)**

Form AD-2002 (07/08)

**U.S. DEPARTMENT OF AGRICULTURE**

**STUDENT VOLUNTEER SERVICE TIME AND ATTENDANCE** **RECORD**

**Student Volunteer Name**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Educational Institution Name and Address**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**USDA Agency/Staff Office Name and Location**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  --------- -------- ----- --------- ----- ----------- ----- ---------- ----- -------- ----- ------- -----
            MONDAY         TUESDAY         WEDNESDAY         THURSDAY         FRIDAY         TOTAL   

            IN       OUT   IN        OUT   IN          OUT   IN         OUT   IN       OUT           

  **^1st^                                                                                            
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  **^1st^                                                                                            
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  --------- -------- ----- --------- ----- ----------- ----- ---------- ----- -------- ----- ------- -----

**Beginning Date of Service Period**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Ending Date of Service Period**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Form AD-2002 (07/08)

**U.S. DEPARTMENT OF AGRICULTURE**

**STUDENT VOLUNTEER SERVICE EVALUATION**

**TO:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Agency/Staff Office Student Employment Program Manager**

**or Other Responsible Official and Educational Institution**

**FROM:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> **Supervisor Name and Organization**

**Student Volunteer Name**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Service Period Covered: From**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**To**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**USDA Agency/Staff Office Name and Location**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1.  **Brief description of work assignments**:

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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2.  **Skills and knowledge gained**:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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3.  **Comments**:

**\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**(Supervisor Signature) (Date)**

Form AD-2002 (07/08)