RETIRED & SENIOR VOLUNTEER PROGRAM
RSVP Volunteer Enrollment Form
  3301 Sinclair, Midland, Texas 79707 (432) 689-6693

Date:_________________________ 

Name:___________________________________________ Phone: (H)____________________

Address:_________________________________________ Phone: (O)____________________

City:__________________________State:______________ Zip:________________

Birth Date: ____/____/____ SS#_________ -_____ -__________

Contact In Emergency:______________________________ Phone:_______________________

How did you hear about RSVP?

  Newspaper
  Friend
  Radio/TV
  Agency where I currently volunteer
  Other__________________________________

RSVP provides free accident liability insurance for all active members while you are volunteering.  Please name a beneficiary for the
accident insurance on the space provided below:

Insurance Beneficiary:__________________________________________________________

Address of Beneficiary:_________________________________________________________
 
  _______________________________________________ Volunteer Signature       

RSVP INTEREST INVENTORY FOR NEW VOLUNTEERS

I. Skills, Interests, and Volunteer Background:

Current/Previous Occupation:______________________________________________________

Hobbies, Interests, Skills:_________________________________________________________

______________________________________________________________________________

___Yes, I am currently volunteering at:______________________________________________

______________________________________________________________________________

___Yes, I am currently volunteering at: _____________________________________________ ,
but would be willing to volunteer at other agencies if my time allows me to.

___No, I do not have a volunteer assignment at the present time and would like to find a place to volunteer.

II. Areas of Interest (please check all activities that interest you)
 

Community/Economic Development:  Human Needs: 
Fund-raising  Outreach Services
Tax Consulting  Senior Center Activities
Thrift Store  Friendly Visitor
Education / Culture:  Housing Construction
Special Education  Handyman Services
Adult Literacy Tutor Reader
Head Start  Telephone Visitor
After-School Tutor  Public Safety: 
ESL  Parent/Child Abuse/Neglect
Cultural Heritage Crime Awareness
Museum Docent  Community Police Patrol
Library Services  Victim/Witness Assistance
Environment:  Neighborhood Watch
Environmental Awareness  Caseworker/Counsel Sexual Assault/Rape
Tree Preservation  D-FY-It Programs
City Clean Up  III. Times Available: 
General:  Sunday  am   pm
Receptionist  Monday  am  pm
Computer Input  Tuesday  am   pm
Typing  Wednesday  am  pm
Filing  Thursday  am   pm
Answering Telephone  Friday  am  pm
Preparing Mailings  Saturday  am   pm
Disaster Preparedness   
Health & Nutrition:  A. Do you have access to an automobile
Delivery of Health Services  you can use for your volunteer work? 
Health Education Yes   No 
Delivery of Meals  B.______ Please add my name to the list of "Minute
Food Packaging  Man" for short term/special projects volunteers. 
Congregate Meals C. Please List any physical conditions that we should
Mental Retardation consider when arranging your assignment___________
Physical Disabilities Programs ______________________________________
Hospice/Terminally Ill D. Suggestions or Comments: __________________
  ______________________________________
  ______________________________________