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RSVP Volunteer Application

Your Information

Preferred Method of Contact
County
Gender
Male
Female
Military Veteran
Yes
No
Are You Bilingual?
Yes
No
Race/Ethnicity
Do you have any health/physical conditions to be considered in arranging volunteer activities?
Yes
No

Emergency Contact

Volunteer Benefits

All RSVP volunteers are covered by supplemental insurance including excess automobile liability, accident, personal liability, and life insurance while volunteering. This coverage is automatic and free of cost to you. Additionally, RSVP volunteers are eligible to be reimbursed for mileage expenses incurred while volunteering.

Do you drive?
Yes
No

I understand that if I use my personal automobile to drive for my volunteer assignment, I will keep in effect automobile liability insurance equal to or greater than the minimum required by Iowa law and a valid driver's license. These are both requirements for the insurance benefit and reimbursement eligibility.

Personal Skills/Qualifications

Personal skills/qualifications are acquired through employment, previous volunteer work, or other activities such as hobbies or sports.

Consents & Signature

By signing this, I certify that the information provided is correct. Your information is never sold, shared, or used outside of Central Iowa RSVP.

May we use your photo for publicity?
Yes
No
Do you, or have you ever, had to report to a probation officer?
Yes
No

Continue to the next page to let us know what volunteer activities you may be interested in.

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