New AVN Member Form

To activate your membership, please provide the information requested below, read the Confidentiality and Conduct Statement and agree to it by providing your electronic signature.

First/Given Name*

Chosen/Preferred First Name

Last/Family Name*

Address*

Country

Street

City

Region

Postal Code

Cell phone number

(hidden) Text Consent

Yes

No

(hidden) Text Consent

Mobile Phone

Preferred AVN email* (Note that this will be your Portal username):

(hidden) Email type

Preferred Method of Contact

High School Name

Employer Name

Work Title

Class Year

AVN activities during the 2023-24 academic year:

Are you currently comfortable participating in these AVN activities?

In Person College Fair

Interview Day

Postcards

Virtual Interview

Do you have an immediate family member applying to college this year?

Yes

No

Student Name:

Please note that volunteers with an immediate family member applying to college (even if they are not applying to Dickinson) will be temporarily inactive during that year. During this time, we wish to avoid any conflicts of interest but will offer our assistance and be a resource for any questions that you may have. We look forward to hearing about your college-search experience and welcoming you back as an active AVN member after your family member’s process is complete. You may contact us at avn@dickinson.edu with any questions you may have.

AVN Confidentiality and Conduct Statement

Recognizing the need to maintain individual and institutional rights to privacy and confidentiality and realizing that, as an agent of the college, my responsibilities necessitate the handling of sensitive information (both individual and institutional), I affirm my intention to preserve the strictest standards of confidentiality in the use of this information and agree to be legally bound by the same regulations affecting all college officials concerning the dissemination and disclosure of sensitive information. Furthermore, in interactions with prospective students, their families and counselors I affirm my intention to adhere to college policies of professional conduct which will be provided to me by the AVN administrators.

Specifically, I affirm that:

I understand the need to exercise confidentiality in the handling of individual and institutional information.

I understand the importance of exercising care and assuring the privacy of my computer system passwords, the physical security of my work area, and the proper storage, transmittal, and disposal of college-based information stored on any media.

I am ethically obliged to report any attempted or successful violation of institutional or personal security or privacy.

I am legally obligated to report to both the Department of Human Services’ Childline (800-932-0313 or https://www.compass.state.pa.us/cwis/public/home) and to Dickinson College any information I encounter, while performing my duties for Dickinson, that suggests a person under the age of 18 is or has been the victim of physical or psychological child abuse.

As an agent of the college, I will review and agree to abide by professional standards outlined in reference material that will be provided to me regarding outreach to prospective students and their families and counselors, interviewing prospective students or representing Dickinson at a college fair.

I understand the intent of this statement and will exercise diligence in performing my duties in accordance with institutional policy.

I have reviewed the Confidentiality and Conduct Statement and that you agree to abide by it in representing Dickinson admissions. Please provide your electronic signature in the space below to confirm.

Default Volunteer Role

(hidden) Status

(hidden) Role