Volunteer Application

Name
First Last
Phone
Alternate Phone
Email
Date of Birth

If you are age 55 or better, you will automatically receive RSVP 55+ Volunteer Program benefits. Details and opt-out box are located at the end of this application.
Gender
- Male
- Female
- Prefer not to answer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Emergency Contact
First Last
Emergency Contact Phone
Emergency Contact Relation
Racial Group
- American Indian or Alaskan Native
- Asian
- Black or African American
- White or Causacian
- Native Hawaiian or Pacific Islander
- Prefer not to answer

References
Reference 1:
(name, and address or phone number)
Reference 2:
(name, and address or phone number)
Reference 3:
(name, and address or phone number)
Skills
The following questions are optional.
What is your educational background/program of study?
Please list special skills and qualifications.
Please list any experiences that could contribute to service (personal and/or professional).
Do you speak, write or understand any language other than English?
- Yes
- No
Language(s)
Why do you want to volunteer for this program?
Please list any additional information you would like us to consider.
How did you hear about Area 10?

RSVP 55+ Volunteer Program
RSVP is a national service program of volunteers (all age 55 and better) making a difference in our community. Joining RSVP helps Area 10 qualify for grants and demonstrate the impact of your volunteer time and expertise. To learn more about the RSVP 55+ Volunteer Program, click here. Joining RSVP does NOT mean you have to do additional volunteering.
RSVP Opt-out:
- Yes, I would like to be registered with RSVP
- Please DO NOT enroll me in RSVP
- I am under 55 years of age
Acknowledgement
I verify that all of the information above is correct and true to the best of my knowledge. I am interested in volunteering at Area 10. I understand that all information is kept strictly confidential. I give Area 10 the right to investigate all references. I hereby release the use of my photograph, and understand that the photograph may be used for a variety of purposes, including, but not limited to, newspapers, websites, brochures, and newsletters. I release RSVP and Area 10 Agency on Aging from any claim which may arise from participation in RSVP or Area 10 activities. My signature also verifies my permission to run a criminal back-ground check and to share this information with any agencies with which I volunteer. I agree to notify Area 10 immediately if anything changes that would affect the results of my background check.
Signature
Today's Date
Comments
This field is for validation purposes and should be left unchanged.

References