AD-2022isntruction

Instructions For [AD-2022]
STUDENT VOLUNTEER PROGRAM SERVICE AGREEMENT
Section 1526 of the Food and Agriculture Action of 1981 [7 US.c. 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 US.c. 3111 [as effected by Part 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 student volunteer reviews this form 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 fonn. This fOlm will be used to
document acceptance of the conditions of program and "vork assignments as required by
OPM and the Agency.
Submit the original of the completed f01111in hard copy to the appropriate USDA
national, state or servicing office.

Items 1-10 are to be completed by the Student Volu/lteer
FldName I I
Item No.

;

_

Instruction

1

Name of
Student

I Enter your name

2
I Enter your social security number
Social
Security No.
3
Telephone
No.
4

Date of
Birth

Page 1 of2

I Enter your telephone number

Enter your date of birth

Items 1-7 are to be completed by the Individual Volunteer

FldName I
Item No.

Instruction

1

Name of
Individual

Enter your name

2

Enter your social security number

Social
Security No.
.,
-'

Enter your home address

Home
Address
4

Enter your telephone number

Telephone
No.
S

Enter your date of birth

Date of
Bilih
6

Agency and
Agreement

7

Signature
and Date

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

If you are mailing or faxing this fonn, print the form and manually enter
your signature and/or that of your parent/guardian. If this fom1 is
approved for electronic transmission and you have established
credentials with USDA to submit forms electronically, use the buttons
provided on the form for transmitting the fonn to the USDA servicing
office.

Item 8 for FFAS use only.

Page 2 of2