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RSVP Volunteer Form

AmeriCorps Seniors Volunteer Enrollment Form

Name *

First

Last

Date of Birth *

Phone Number *

Email *

Address

Are you a veteran? *

Yes
No

Please list any physical or medical limitations:

Have you ever been convicted of a criminal offense or misdemeanor? *

Yes
No

If Yes, please list an explanation of charges, date of offense, and status of the charges.

Driver's License # *

State *

Exp. Date *

AmeriCorps Seniors RSVP provides a mileage reimbursement for travel between home and volunteer site to the volunteers. Will you be claiming a mileage reimbursement for travel to and from your volunteer site location? *

Yes
No

List an Emergency Contact *

First

Last

Emergency Contact's Phone Number *

Beneficiary for AmeriCorps Seniors RSVP Supplemental Accident Insurance *

First

Last

Relationship with Beneficiary *

Beneficiary's Address *

Beneficiary's Phone Number *

Please list a brief description of your employment experience in the box below. *

List any special skills, interests, and/or languages spoken in the box below. *

Please list a brief description of your volunteer experience (current, past, or preferred type of tasks) in the box below. *

Volunteer Availability

Monday
Tuesday
Wednesday
Thursday
Friday

Check all that apply

Time of Day

Morning
Afternoon

Check all that apply

Please indicate if Align9 may have your permission to use your likeness?

I hereby grant Align9 permission to use my likeness in photograph(s)/video(s) in any and all of its publications or on the world wide web, whether now known or hereafter existing, controlled by Align9 Morgan, Loudon, Meigs counties in perpetuity. I will make no monetary or other claim against Align9 for use of these photograph(s)/video(s).
I do not give permission to use my likeness in photograph(s)/video(s) to Align9.

I hereby state that I am 55 years of age or older and offer my service as a volunteer for the Align9 Retired Senior Volunteer Program (RSVP). I understand that I am not an employee of the AmeriCorps Seniors RSVP Project, Align9, the volunteer station or the Federal Government. I agree to serve without compensation. *

I agree.
I do not agree.

I understand that in my capacity as an AmeriCorps Seniors volunteer 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. *

I agree.
I do not agree.

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 TN. I will also keep in effect a valid TN Driver's License. *

I agree.
I do not agree.

Occasionally Align9 RSVP will purchase volunteer recognition gifts for AmeriCorps Seniors volunteers. Please share the size you would prefer for: JACKET/SWEATSHIRT

Occasionally Align9 RSVP will purchase volunteer recognition gifts for AmeriCorps Seniors volunteers. Please share the size you would prefer for: VEST

Occasionally Align9 RSVP will purchase volunteer recognition gifts for AmeriCorps Seniors volunteers. Please share the size you would prefer for: HAT

Occasionally Align9 RSVP will purchase volunteer recognition gifts for AmeriCorps Seniors volunteers. Please share the size you would prefer for: SHOE SIZE (for snow cleats

Which show of appreciation would mean the most to you? (Check all that apply)

Specially arranged meals
Gifts
Certificates
Logo Wear (Merch)
Being chosen as the Volunteer of the Month
Being highlighted in the newsletter
Other

If you selected Other, please share your suggestion for volunteer appreciation in the box below.

AmeriCorps Seniors RSVP is often asked to provide demographical information pertaining to volunteers. Please provide the following information: Are you a veteran?

Yes
No

Are you an active Military Member?

Yes
No

Are any of your family members actively serving in the military?

Yes
No

Gender:

Male
Female

Race/Ethnic Background:

White
Asian
African-American
Hispanic/Latino
American Indian/Alaska Native
Pacific Islander
Other

Align9 RSVP is an equal opportunity Agency. Enrollment is done without regard to race, color, religion, national origin, gender, age, or disability. AmeriCorps RSVP provides reasonable accommodations to the known disabilities of individuals in compliance with Americans with Disabilities Act. For accommodation information, or if you need special accommodations to complete the application process, please contact Align9 RSVP at (865)-850-9590.

Thank you for the information you provided. Your information is never sold, shared, or used outside of AmeriCorps Seniors RSVP, Align9, or AmeriCorps Seniors.

Home
About
Media
Resource Guides
Projects
Partners
Our Community Cares
Volunteer
Donate
Cara Project
CPRS

Building stronger communities through collaboration of government agencies, non-government organizations and faith based communities.

This project is funded under a grant contract with the State of TN department of mental health and substance abuse services

Align9 is committed to ensuring that no person is excluded from participation in, or denied the benefits of its services on the basis of race, color or national origin, as protected by Title VI.

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