AD-2023intruction

Instructions For [AD-2023]
INDIVIDUAL VOLUNTEER PROGRAM SERVICE AGREEMENT
Section 1526 of the Food and Agriculture Action of 1981 [7 U.s.e. 2272] permits the
Secretary of Agriculture to establish a program to use volunteers to perform a wide range
of activities to carry out the programs of or supported by of the Department of
Agriculture. 5 U.S.e. 3111 [as effected by Pati 308 of Title 5, Code of Federal
Regulations] grants agencies the authority to establish programs designed to provide
educationally related work assignments for students in non-pay status.
The Volunteer Programs require volunteers to read, sign and date a "Program Service
Agreement" explaining the conditions or limitation of acceptance of assignments. The
"Service Agreement" will serve as the volunteer's official record of appointment of
service. The "Attendance Record" will serve as the volunteer's official attendance
documentation.
The individual volunteer reviews this fonn and signs and dates it and provides some basic
demographic information to document that he/she understands the program's conditions
of service. Each volunteer will sign and date this form. This fOll11will be used to
document acceptance ofthe conditions of program and work assiglU11entsas required by
aPM and the Agency.
Indicate how and where to send the completed form here. Example: Submit the
original of the completed form in hard copy or facsimile to the appropriate USDA
servicing office. To submit this form by facsimile you must have submitted an
original signature on FSA-237, Facsimile Signature Authorization and Certification.
If electronic signature is authorized for the form include the following standard text also. If the
form is not authorized for electronic signature delete both paragraphs ..

Customers who have established electronic access credentials with USDA may
electronically transmit this form to the USDA servicing office, provided that (1) the
customer submitting the form is the only person required to sign the transaction, or
(2) the customer has an approved Power of Attorney (Form FSA-211) on file with
USDA to sign for other customers for the program and type of transaction
represented by this form.
Features for transmitting the form electronically are available to those customers with
access credentials only. If you would like to establish online access credentials with
USDA, follow the instructions provided at the USDA eForms web site.

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FldNamel

Instruction

Item No.
5

Enter your home address

Home
Address
6

Enter your educational institution

Educational
lnsti tution
7

Enter your student's academic status

Student's
Academic
Status
8

Enter your academic major

Student's
Major
9

Agency and
Agreement

10
Signature
and Date

Enter the employing Agency
Read the agreement which sets the conditions for the acceptance of
student volunteers
The following is standard language for signature fields.

If you are mailing or faxing this f01111.print the fonn and manually enter
your signature and/or that of your parent/guardian. If this f01111is
approved for electronic transmission and you have established
credentials with USDA to submit f0l111Selectronically, use the buttons
provided on the form for transmitting the fonn to the USDA servicing
office.

Items 11- 12 arefor FFAS use only.

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