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									                                                    RSVP
                                          Volunteer Resource Center
                                           “Answering the Call to Serve”
                                             ENROLLMENT FORM

MORRIS                      PASSAIC COUNTY        SUSSEX COUNTY            WARREN & HUNTERDON COUNTY
P.O. Box 563               476 17th Avenue        P.O. Box 393             350 Marshall Street
Denville, NJ 07834         Paterson, NJ 07504     Franklin, NJ 07461       Phillipsburg, NJ 08865
(973) 784-4900 x 102       (973) 647-9862         (973) 209-7487           (908) 454-7000 x 142(warren) x 144(hunterdon)


Enrollment Instructions:

This enrollment asks you to describe the skills and experience you offer to RSVP Volunteer Resource Center, as
well as the reasons why you wish to serve. Consider each section carefully and respond to the best of your
ability. Think about your role in service activities, membership in community organizations, academic
experiences and personal talents. Take into account everything from your past and present. Your enrollment
and personal references help create a full picture. Make sure this enrollment accurately reflects all the qualities
that make you a good member of RSVP Volunteer Resource Center.

Member Profile:

Name: _____________________________________________________________________________
       (First)                          (MI)                       (Last)
Date of Birth: ____/___/_____ Age: _______   Gender: Female   Male

Home Phone (           )                   Other (      )                             E-mail______________________

Address: __________________________________________________________________________________
         (Street)                                   (City, State, Zip)
Emergency Contact: _____________________ Relationship ___________________ Phone: _(___)_________

Are you a U.S. Citizen or a Permanent Resident Alien?             Yes         No

How did you hear about RSVP Volunteer Resource Center? _________________________________________

What is your method of transportation?           Car        Bus     Bike       Walk       Other

What county do you prefer to volunteer in?           Warren       Sussex     Morris       Hunterdon       Passaic

When are you available to volunteer:            Weekdays      Weeknights           Weekends       Specific __________

What town would you prefer to volunteer in? ____________________________________

Background Information: This information is optional and will in no way affect your selection into the
program.

        1. Describe your ethnic background:    African American   Asian American/Pacific Islander
                  White/Non-Hispanic      Hispanic/Latino   American Indian/Alaskan Native    Other

        2. Do you have any special needs that require accommodation? Yes No
           (specify) ________________________________________________________
Personal Statement: Please answer the following questions; you can use a separate sheet to attach.

       Why do you want to join RSVP Volunteer Resource Center?



        What are your most important skills or experience that will help you contribute to RSVP?



Community Activities: Please list and describe some of your volunteer activities, include social, school,
professional and neighborhood projects and programs. Please feel free to attach additional information.


Education Background:

          High School/GED               Some College           College Degree      Specialty Degree

Employment Background: Please tell us a bit about your employment background.



Skills: Please check below any of the areas that you may have some skills or experience:

   Aid Homeless                  Bloodmobile           Board Member                  Career Management
   Carpentry                     Child Advocate        Child Care                    Classroom Aide
   Computer Aide                 Courier               Crime Prevention              Crisis Hotline
   Disabled Adults               Disabled Children     Disaster Preparedness         Disaster Response
   Docent                        Driver                Drug Abuse Prevention         Economic Development
   Electrical Repairs            Emergency Food        Emergency Response            Environmental Issues
   Exercise Leader               Facilitator           Financial Mentor              Friend of the Blind
   Friendly Visitor              Fund Raising          General Maintenance           General Office Work
   Grocery Shopper               Health & Safety       Home Safety Assessment        Homeland Security
   Housing Issues                Income Tax Prep.      Instructor                    Library Aide
   Literacy Instruction          Mailings              Management                    Marketing
   Meal Delivery                 Meal Preparation      Medicare Education            Mentor
   Money Management              Monitor               Neighbor to Neighbor          Office Assistant
   Outreach                      Parenting Aide        Plumbing                      Public Relations
   Public Speaking               Read to Children      Read to the Blind             Research
   Senior Nutrition              Sit on Committees     Special Events                Support Group Leader
   Teach Life Skills             Teaching              Telephone Reassurance         Tour Guide
   Transport Seniors             Tutor                 Web Design                    Other ________________

Do you have any other special skills that you can offer: _____________________________________________

Any special languages you speak other than English? ______________________________________________

What is or was your previous occupations? _______________________________________________________

Additional Information: Please attach additional information that you think will help us match your skills with
the volunteer opportunity.
Beneficiary for RSVP Volunteer Resource Center Insurance:

Name:_____________________________________________ Relationship: ___________________________

Address: ____________________________________________________                   Phone:_____________________
             Street            City              State/Zip

Excess Automobile Liability Insurance:

As an RSVP Volunteer, I, _______________________________ understand that if I use my personal
automobile for related activities, including commuting between my residence and work station, I will arrange to
keep in effect Automobile Liability Insurance equal to the minimum limits required by my State. I understand
that excess Automobile Liability Insurance will be provided by RSVP. I will also maintain a current and valid
driver’s license.
                                       Volunteer Signature __________________________ Date____________

License and Insurance Information: Please provide the following:

Auto Insurance Company: ________________________________________ Exp. ______________________
Auto Insurance Policy #: _________________________________________
Driver’s License #: ________________________________________ State: ______________

Background Checks: Certain volunteer opportunities will require a background check. If you are in a position
that requires a background check you will receive paperwork to complete before you begin to volunteer.

Reporting Mileage and Hours: Timesheets/Hours are due by the 10th of the following month that they are
performed. After you have been matched you will receive paperwork explaining the different ways you can
report your hours. Mileage is turned in with your timesheet; mileage is paid on a quarterly basis. Mileage is
$.25/mile up to a maximum of $25.00 per month. When reporting mileage you MUST HAVE A
SUPERVISOR SIGNATURE.

Certification: This enrollment must be signed by the volunteer. By signing this enrollment you are stating that
all of the information provided is true to the best of your knowledge and that you understand that confidentiality
will be maintained.

_____________________________________________               _______________________________________
Program Director                                             Date

_____________________________________________               ______________________________________
Volunteer Signature                                         Date


For Office Use:

Enrollment Date:________________________________

Volunteer Site: _________________________________

Assignment/Activity: ____________________________

								
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