RSVP Volunteer Application Form

Today's Date*:
Email Address*:
Ms. Miss Mrs. Mr.
Full Name*:
Are you 55 or older?* Yes. No Age*:
Town*: Zip Code*:
Phone Number*:
Cell Phone Number:
Ethnicity: Hispanic/Latino Not Hispanic/Latino
Racial Group: American Indian/ Alaska Native American Asian
  African American or Black Hawaiian/Pacific Islander White
Kind of volunteer work desired*:
Time Available*:
  Hours: Days:
  Months: Starting:
Do You Have a Car?* Yes. No
Drivers License?* Yes. No
Liability Insurance?* Yes. No
Are you a Veteran? Yes. No
Are there any physical conditions and or limitations that should be taken into consideration in arranging volunteer assignments for you?*
Emergency Contact*:
  Relationship*: Phone*:
Previous work or occupation*:
Education and Training*:
General Interests*
Previous volunteer service?
Most recent service?
Please state why you would like to join RSVP*
What would you like to do as a volunteer?*
How did you learn about RSVP?*
How far are you willing to travel?*