A4.7 Sample: Agency/Learner Agreement

I, (learner name) want to enter the (name) adult tutoring program.

• I agree to spend hours per week for a period of weeks.
• I understand that regular and writing will help my skills.
• I understand that I may be evaluated or interviewed by representatives of (agency.)
• I agree to respect the time and energy of my volunteer tutor and the (agency.)
• If possible I will notify my tutor if I must miss a meeting time.
• I will work to support the service of the (agency) by offering ideas and suggestions.
• I have read or had explained to me the (relevant policies and procedures) so I understand how this agency operates.
• I understand that my file may be viewed by and . All others will ask my permission first.

Learner: Date:

Staff Representative: Date:

This agreement may be cancelled at any time by either of the parties, but will expire automatically on (date) unless renewed by both parties.

(Reprinted, in adapted format, from Volunteer Management Forms, with kind permission of author, Steve McCurley.)