Unpaid Volunteer, Intern and Visiting Scholar Request Form

Please review the OHR Policy on Unpaid Volunteers, Interns, and Visiting Scholars prior to submitting this form. You will also need to complete this Background Request Form unless your individual to perform the activity meets one of the exceptions in the Definitions and Additional Information below. If a volunteer(once approved) or IC needs a PID for UNC access, please complete this Affiliate Access Form. Please review the DEFINITIONS AND ADDITIONAL INFORMATION before moving forward.

DEFINITIONS AND ADDITIONAL INFORMATION:

Volunteers are individuals who offer their services without cost to the university for civic reasons and which are not typically performed by permanent university employees. Examples include serving as a docent at a university museum or educational facility, serving as an usher at a university special event, or otherwise performing duties that are of benefit to the university’s teaching, research, and/or public service mission.

Ongoing duration is only available for Unpaid Volunteers that meet the following standards:

· Will be performing the same duties each instance of service.

· The service(s) is provided intermittently for short durations of time (i.e. 10 days twice a year).

· The service(s) will be performed over multiple consecutive years.

· The service(s) must be performed at the same time(s) of year.

Unpaid interns are individuals who meet one of the following circumstances:

· Are currently enrolled at UNC-Chapel Hill or other accredited colleges, universities, community colleges or high schools and who are engaged in experiential learning in the workplace in return for academic or course credit.

· Are obtaining work experience that is required for professional licensure or certification under the supervision of a licensed or certified professional (e.g., Social Workers, Engineers, Nurses, and Accountants) for a period not to exceed 18 months in duration.

· Are engaging in experiential learning in a profession under the supervision of an appropriate University supervisor or manager for a period not to exceed 18 months in duration.

Unpaid visiting scholars are individuals who hold appointments at other academic or research institutions and are visiting to work with a particular faculty member or principal investigator on a research project but do not receive a paid appointment at UNC-Chapel Hill.

Exclusions: Individuals who will perform volunteer services not to exceed ten calendar days in duration without any continuing volunteer relationship, if the assignment does not involve any unsupervised access to sensitive populations or sensitive facilities and if the individual is not otherwise an employee of the University. Note: This exclusion includes individuals who are invited to deliver a talk or presentation at the University without pay or only for nominal benefits related to their services.

Sensitive populations are those including individuals under 18 years of age, patients receiving care in any clinical setting, or other individuals deemed to require enhanced supervision or protection based on university practice or state or federal law.

Sensitive facilities are university facilities that require special clearance or background checks for access or that permit unsupervised access to records that are confidential or otherwise have special protections under state or federal law.

Sensitive Information: Tier 2 and Tier 3 information is “Sensitive Information” for the purposes of interpreting existing University policies, standards, procedures, and other documents. It is incumbent upon organizational units handling any sensitive information to evaluate classification and control, and to apply stricter standards when appropriate. Those items in the University Records Retention Schedule with a “Confidential” notation are likely to contain elements which would require a Confidential or Restricted classification.

Tier 2: Confidential Information is the default classification of University information until determined otherwise. Confidential Information includes information which the University is required by law, regulation, contract, policy, or other governing requirement to keep confidential.

The following are examples of Confidential Information elements:

Education records such as grades and class schedules
The University’s proprietary information including, but not limited to, intellectual research findings, intellectual property, financial data and donor/funding sources not otherwise classified under this standard
Confidential personnel file information protected by the N.C. Human Resources Act, including criminal background check results
Attorney-client communications
Information subject to a confidentiality agreement
Information protected by contractual agreements or non-disclosure agreements such as vendor product roadmaps, bid documents sealed for a limited time.

Tier 3: Restricted Information includes any information that the University has a contractual, legal or regulatory obligation to safeguard in the most stringent manner. Unauthorized disclosure or loss of this information may require notification.

The following are examples of Restricted Information:

Education records such as disciplinary conduct reports, student health information, sexual assault reports, passports, or financial aid information
Some types of Federal Policy for the Protection of Human Subjects “Common Rule” data that remains identifiable
Personal Health Information as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Information covered by the North Carolina Identity Theft Protection Act of 2005
Payment Card Industry (PCI) information related to merchant activity
Export controlled information (ITAR/EAR)
Information covered by Gramm-Leach-Bliley Act (GLBA)
Information protected by contractual obligations such as vendor information security documentation
Passwords
Social Security Numbers (SSNs)

Background checks are required for all volunteers, unpaid interns and unpaid visiting scholars with the following exceptions:

· Permanent employees and UNC-Chapel Hill Students who do not have unsupervised activity with sensitive populations or sensitive facilities

· High school students

· Those under 18 years of age

· UNC-Chapel Hill Students currently enrolled at UNC-Chapel Hill, if the volunteer or intern assignment does not involve any unsupervised access to sensitive populations or sensitive facilities and the individual is not otherwise a non-student employee of the University, a background check is not required if the unpaid activity otherwise conforms to the above provisions.

All others must have a Background Check completed.

Employment of Related Persons: For the Employment of Related Persons policy relating to SHRA permanent employment, click here. For the Employment of Related Persons policy relating to EHRA employment, click here.

Unpaid Volunteer, Intern, and Visiting Scholar Request Form

Please complete the following questions below:

Individual to Perform Activity
Is this a current UNC-CH student?*
What is the student's Personal Identification Number (PID):*
Has this person ever been affiliated with UNC-CH?*
Please list the person's UNC-CH Personal Identification Number (PID):
Name:*
First Last
Birth Date:*
MM slash DD slash YYYY
Appointing University Official is "Closely Related" (per Employment of Related Persons Policy)"*
The link to this policy can be found in the Definitions section of this form.
Department is requesting*
Please select from the following choices.
Background Check Satisfactorily Completed?*
Name of Home Institituion:
Country of Home Institution:
Individual holds a Visa (J-1 or H-1B) sponsored by UNC?*
Individual is a U.S. Citizen or Permanent Resident (green card). Citizenship information will only be used to determine the University's compliance obligations in connection with this request.*
List the individual's country or countries of citizenship. Citizenship information will only be used to determine the University's compliance obligations in connection with this request.*
High School Student working in a lab?
If a minor has graduated from high school and will be a matriculated undergraduate student in the upcoming semester they still must complete High School (Minor) Laboratory Worker Departmental Agreement Form in accordance with the University’s High School Student and Minors in Laboratories Policy.
Dept Number
Department Contact Name and Email Address:*
Describe Activities and Specify Environment Setting:*
Beginning Date:*
MM slash DD slash YYYY
End Date:*
MM slash DD slash YYYY
Unsupervised Activities
Involves Unsupervised Activities with any of the following: Sensitive Populations, Sensitive Facilities, and Sensitive Information. See Definition section for links.
Sensitive Populations?*
Sensitive Facilities?*
Does this include work with minors?*
Sensitive Information?*
Description of Sensitive Populations/Facilities (if applicable). (Example: students, patients, study participants, biosafety level 3 facilities (BSL-3) etc.)*
Please Upload the appropriate Release of Liability Form.*
Max. file size: 10 MB.
The Release for Unpaid Volunteers & Interns can be found in- this link, the Release for Unpaid Visiting Scholars can be found in : this link
Supervisor Name and Email:*
Supervisor PID Number:*
Submitter's Name*
Submitter's Email*

Unpaid Volunteer, Intern and Visiting Scholar Request Form

Unpaid Volunteer, Intern, and Visiting Scholar Request Form

Individual to Perform Activity

Unsupervised Activities