Application for RSVP Volunteers
Name (first & last):
Date:
Home Address (Street or PO Box):
City:
State:
Postal Code:
Phone:
E-mail Address:
Sex:
M
F Race:
Birth Date:
Tribal member:
Yes
No Veteran:
Yes
No Disabled:
Yes
No
Education:
Some high school
Completed high school
Some college
Completed college
Some graduate school
Completed graduate school
Employment Status:
Full-time
Part-time
Retired
Previous Work/Occupation:
Volunteer Experience:
Any Physical Limitations:
Housing Type:
Multi-family
Mobile home
Single-family
None
Do you
rent or
own?
How did you learn about RSVP?
Brochure
Word-of-mouth
TV Commercial
Other:
Kind of Volunteer Assignment Desired (In order of preference)
1.
2.
3.
Days Available (check all that apply):
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Any Months Not Available (check all that apply):
January
April
July
October
February
May
August
November
March
June
September
December
Comments:
NONE
RSVP Accident Insurance Beneficiary:
Name (first & last):
Date:
Home Address (Street or PO Box):
City:
State:
Postal Code:
Phone:
Relationship:
In case of emergency, contact (first & last name):
Phone:
I hereby volunteer my services through the Retired and Senior Volunteer Program of Gallatin and Park Counties. If I use my car in volunteer service, I will keep in effect the minimum Liability Insurance.
Accept
Decline
Check all items for which you would consider volunteering and/or have experience. You may update this later. A checkmark reflects your interests, not your commitment.
Length of Commitment:
Short term
Ongoing
One-time event / project
I prefer to work with:
Alone
Group Setting
Independently
Outdoors
Indoors
Quiet Setting
Fast-paced
No Preference
I prefer to work with:
Physically Disabled
Seniors
Teens
Animals
Developmentally Disabled
Adults
Children/Youth
No Preference
What focus areas interest you the most? (check all that apply):
Education/Literacy
Hunger/Nutrition
Animals
Youth Development
Housing/Shelter
Adult Day Center
Seasonal/Special Events
Arts/Historical
Disabilities
Physical Abuse/Neglect
Health/Wellness
Recreation
Legal/Consumer
Environmental
Transportation
Other (Specify):
Special training and skills, interests or hobbies (check all that apply):
Accountant/Bookkeeping
Food Serving
Clerical
Community Organizing
Animal Care
Gardening
Teaching/Tutoring
Receptionist
Art Work
Committees/Boards
Administrative
Computer
Cooking/Cleaning
Carpentry
Data Entry
Electrical Work
Reading Aloud
Languages
Writing/Journalism
Public Speaking
Mass Mailing
Tax Preparation
Companionship
Bingo Calling
Foot Clinic
Immunizations
Blood Pressure Checks
Classroom Aide
Telecare
Handcrafts
Library Aide
Gift Wrapping
Meal Delivery
Selling Merchandise
Food Bank Worker
Second Hand Store
Visitor Information
Road to Recovery
Greeter/Ticket Taking
Museum Docent
Other (Specify):
