[Thisisonlyasample.Projectsare encouragedtocustomizeasappropriate]

MemorandumofUnderstanding

betweenthe

[SponsorName)Foster GrandparentProject

Address

City,State

and

Volunteer Station:

hereinafterreferredtoas"VolunteerStation".

Address:

Telephone: Fax: E-mail_

VolunteerStationExecutiveDirector/CEO:

Period Covered: to

ThisMemorandumofUnderstanding(MOU) containsbasicprovisions,whichwillguide theworkingrelationshipbetween both parties.ThisMOUmaybeamended,inwriting,at anytimewithconcurrenceofbothpartiesand mustberenegotiated atleasteverythree years.

BASICPROVISIONSOFMEMORANDUMOFUNDERSTANDING A.[SponsorName)FosterGrandparentProjectResponsibilities:

1. Recruit,interview,select,andenrollvolunteersintheprogram.Thevolunteerswill meetthecriteriaintheFosterGrandparentProgram(FGP)FederalRegulationsfor enrollmentintheprogram.

2. Unlessotherwisespecifiedherein,conductanddocumentacriminalhistorycheckfor allFosterGrandparentsinaccordancewiththerequirementsestablishedfora

NationalServiceCriminalHistoryCheckbytheCorporationforNationaland

CommunityService

3. Arrangeforannualphysicalexaminationsforupto_FosterGrandparents (includinga20%turnoverrate)at$ perexamination. Donorverifiesfundsare notfromotherfederalsourcesunlessauthorizedunderlaw.

4Provideaccidentandliabilityinsurancecoverageasrequiredbytheprogram includingexcessautomobileliabilityinsuranceforFosterGrandparentswhodrivein connectionwiththeirservice.

5. Beresponsibleforthemanagementandfiscalcontroloftheprogram.

6. Provideorientationtovolunteersandprovidein-servicetrainingonanon-goingbasis.

7. ProvideorientationtoVolunteerStationstaff.

B. VolunteerStation Responsibilities:

1. ForeachFosterGrandparentandforeachchildserved,developandobtainthe Sponsor'sapproval,ofawrittenAssignmentPlanthatidentifiesthechild(ren)tobe servedandtheroleandactivitiesofthevolunteeractivities,theexpectedoutcomes foreachchild,andthataddressestheperiodoftimeeachchildshouldreceivesuch services. ThisAssignmentPlanwillbesignedbytheVolunteerStationliaisonand thevolunteerandwillbeusedtoreviewtheFosterGrandparent'sservicesaswellas, theimpactoftheassignmentonthechild'sdevelopment.

2. Assureadequatehealthandsafetyprovisionsfortheprotectionofvolunteers.

3. Investigateincidents,accidentsandinjuriesinvolvingvolunteersandnotify.theFoster

GrandparentProjectonatimelybasis.

4. Assignchildrenwithdesignatedspecialorexceptionalneedsorwhoarein circumstancesthatlimittheiracademic,social,oremotionaldevelopment,whoare lessthan21yearsofagetoeachvolunteer.

5. Providesite.specificorientation andtrainingtothevolunteers.

6. SubmitrequiredcompletedpaperworktotheFosterGrandparentProjectonatimely basis,i.e.,individualVolunteerAssignmentPlanspriortoassignment,volunteer timesheets,VolunteerimpactEvaluations,andVolunteerPerformanceEvaluations.

7. If mealsareprovidedtovolunteers,pleasecompletethisportion: () ContributedmealsareFEDERALLYFUNDEDunder:

TitleIIIoftheOlderAmericansAct

Other(federal)fundingsource

()ContributedmealsareNOTprovidedbyFEDERALFUNDS. Meals

willbeprovidedtoFGPvolunteersatafreeorreducedpricewhen hoursof servicehasbeenorwilll:levolunteeredduringthatday.

NOTE:Thevalueoffreeorreduced-pricemealswhichisnotprovidedby

federalfundswillbeverifiedbytheVolunteerStationSupervisorand reportedmonthlytotheFGPproject.Thisdocumentsimportantin-kind supportforFGP.

8. Ensurethat FosterGrandparentsserveinavolunteercapacity. TheStationwillverify thatFosterGrandparentswillnot:displacenorreplacepaidorcontractedemployees, relievestaffoftheirroutinedutiesorinfringeuponthesitesupervisor'ssupervisory rolewiththechildren.

9. SuperviseFosterGrandparentsatalltimeswhiletheyareperformingasvolunteers andnotleavetheFosterGrandparentalonewithchildren.

10.Ensurethatanyscreeningprocessesrequiredof othervolunteersatthestationare requiredfortheFosterGrandparentvolunteers.

11.ProvideconfidentialitytrainingforallFosterGrandparentsinaccordancewithstation policiesandprocedures. (e.g.,schooldistrictswillprovideconfidentialitytrainingin accordancewithStateEducationlaws,rulesandregulations,FederalRegulationsand statutes,includingtheBuckleyandHatchAmendments.)

12.ImplementProgramming forImpactatthevolunteerplacementsite(s)inorderto assisttheFosterGrandparentProjectinevaluatingtheimpactFosterGrandparents haveonthechildrenservedandthecommunity.

13.Periodicallyrevieweachchild'scontinuingneedforaFosterGrandparentand recommendphase-outorreassignmentoftheassignedFosterGrandparent,as necessary.

14.Forin-homeassignments,theVolunteerStationwillobtainaLetterofAgreement signedbythepersonorpersonslegallyresponsibleforthechildserved,theVolunteer Stationliaison;andtheFGPliaisonauthorizingtheassignmentofaFoster Grandparentinthechild's home,definingtheFosterGrandparent'sactivities,and specifyingsupervisoryarrangements.

15.AccessibilityandReasonableAccommodation:TheVolunteerStationwi]lmaintain theprogramsandactivitiestowhichFGPvolunteersareassignedaccessibleto personswithdisabilities(includingmobility,hearing,vision,mental,andcognitive impairmentsoraddictionsanddiseases)and/orlimitedEnglishlanguageproficiency andprovidereasonableaccommodationtoallowpersonswithdisabilitiesto participateinprogramsandactivities.

I6.ReligiousActivities: TheVolunteerStationwillnotrequestorassignFGPvolunteers toconductorengageinreligious,sectarian,orpoliticalactivities.

I7.Displacement ofEmployees: TheVolunteerStationwillnotassignFGPvolunteersto anyassignment whichwoulddisplaceemployedworkersorimpairexistingcontracts forservices.

18.Prohibition ofDiscrimination:TheVolunteerStationwillnotdiscriminateagainst FGPvolunteersorintheoperationofitsprogramonthebasisofrace;color;national origin,includinglimitedEnglishproficiency;sex;age;politicalaffiliation;sexual orientation;religion;oronthebasisofdisability,ifthevolunteerisaqualified individual withadisability.

19.TheVolunteerStationwillnotdiscriminateagainstFosterGrandparentvolunteersor intheoperation ofitsprogramonthebasisofrace;color;nationalorigin;limited Englishlanguageproficiency;sex;age;politicalaffiliation;sexualorientation; religion;oronthebasisofdisability,ifthevolunteerisaqualifiedindividualwitha disability.

BysigningthisMOU,theVolunteerStationRepresentativecertifiesthatthevolunteer stationisapublicornon-profitprivateorganization,oraproprietaryhealthcareagency.

SPONSORNAMEVOLUNTEERSTATIONNAME

BY: By:

(Signature) (Signature)

Title:ProjectDirectorTitle:

FosterGrandparentProject.

Address:

City,State,Zip

Address:

City,State,Zip

Date:._Date:_