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RETIRED SENIOR VOLUNTEER PROGRAM
RSVP
RSVP is exclusively for volunteers 55 or over. Please complete this application to start the process of becoming an RSVP Volunteer. We are looking forward to helping you find the right volunteer opportunity for you!
RSVP Volunteer Enrollment Form
RSVP Volunteer Enrollment Form
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Please complete all sections and submit to apply as a volunteer for the Region 10 Senior Volunteer Program.
Volunteer Basic Information
Name
Birth Date
Email Address
Phone
Mailing Address
Mailing Address
Mailing Address
Mailing Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Are you a Veteran?
Yes
No
Do you have any Physical or Medical limitations?
Have you ever been convicted of a criminal offense or misdemeanor?
Yes
No
If yes, please please give an explanation of charges, date of offense, and status of the charges.
Driving
AmeriCorps Seniors RSVP provides a mileage reimbursement to volunteers for travel reimbursement between home and volunteer site.
Driver's License #
State
Driver's License State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Expiration Date
Will you be claiming a mileage reimbursement for travel to and from volunteer location?
Yes
No
If yes, will you be able to provide proof of active auto insurance coverage upon request?
Yes
No
Emergency Contacts
Primary Emergency Contact
Primary Contact Phone #
Secondary Emergency Contact
Secondary Contact Phone #
Beneficiary for AmeriCorps Seniors RSVP Supplemental Accidental Insurance
Relationship to you
Beneficiary Address
Beneficiary Address
Beneficiary Address
Beneficiary Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Beneficiary Phone #
Check the MORNINGS during the week when you are available to volunteer:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Check the AFTERNOONS during the week when you are available to volunteer:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Check the EVENINGS during the week when you are available to volunteer:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many hours do you think you would like to volunteer each week?
Do you have allergies we should know about?
Yes
No
If yes, what are they?
Employment Experience
Special Skills/Interests/Languages:
Volunteer Experience (Current, Past, Preferred):
Certification
By checking the yes box below each statement, I acknowledge that I have read and understand the following statements:
I hereby state that I am 55 years of age or older and offer my services as a volunteer for the Region 10 Retired Senior Volunteer Program. I understand that I am not an employee of the AmeriCorps Seniors RSVP Project, Region 10 RSVP, the volunteer station, or the Federal Government and agree to serve without compensation.
Yes
No
I understand that in my capacity as an AmeriCorps Seniors volunteers in RSVP I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.
Yes
No
I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Colorado. I will also keep in effect a valid Colorado Driver's license.
Yes
No
Signature
Clear
Next
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For Seniors
All Resources
Aging and Disability Resource Center
Area Agency on Aging
Long Term Care Advocates
RSVP – Region 10 Senior Volunteer Program
Senior Companion Program
State Health Insurance Assistance Program
Senior Resource Directory
For Caregivers
For Professionals
News
Trainings/Meetings
Resources by County
For Businesses
Funding
Training
SBDC Consulting
Incentives/Tax Credits
News
Trainings/Meetings
Resources by County
For Communities
Community Development
Regional Economic Development Plan
Regional Data Dashboard
Enterprise Zone Tax Credits
Broadband
Transportation
News
Trainings/Meetings
Resources by County
ABOUT
About Us
Board Of Directors
Staff
Work With Us
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FOR SENIOR SERVICES
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