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Anoka County RSVP (Retired and Senior Volunteer Program) Volunteer Enrollment Form

2. PRIVACY NOTICE
   PLEASE NOTE: ANOKA COUNTY TAKES YOUR PRIVACY VERY SERIOUSLY. WE WILL TAKE EVERY AVAILABLE PRECAUTION TO MAINTAIN THE SECURITY AND INTEGRITY OF YOUR PRIVATE INFORMATION. PRECAUTIONS HAVE BEEN TAKEN TO MAKE ANOKA COUNTY’S WEBSITE AND E-MAIL SECURE, BUT ABSOLUTE SECURITY IS NOT GUARANTEED. IF YOU CHOOSE TO SUBMIT YOUR INFORMATION ELECTRONICALLY, YOU ASSUME ANY RISKS ASSOCIATED THEREWITH.

   PLEASE NOTE: ANOKA COUNTY TAKES YOUR PRIVACY VERY SERIOUSLY. WE WILL TAKE EVERY AVAILABLE PRECAUTION TO MAINTAIN THE SECURITY AND INTEGRITY OF YOUR PRIVATE INFORMATION. PRECAUTIONS HAVE BEEN TAKEN TO MAKE ANOKA COUNTY’S WEBSITE AND E-MAIL SECURE, BUT ABSOLUTE SECURITY IS NOT GUARANTEED. IF YOU CHOOSE TO SUBMIT YOUR INFORMATION ELECTRONICALLY, YOU ASSUME ANY RISKS ASSOCIATED THEREWITH.

4. Your Information

6. First Name*

7. Last Name*

9. Address1*

11. Address2

13. City*

14. State*

15. Zip*

17. Phone*

18. Email Address

20. How did you hear about RSVP?

22. Work Experience

23. Currently volunteering at

25. Please list any special training, experience, skills, hobbies or interests you have

27. How do you plan to travel to your volunteer assignment?*

    This information is required for your liability insurance benefits. Check all that apply.

    1. Drive (you will be asked to submit your DL# and insurance info by phone call)
    2. Ride with friend/spouse
    3. Bus/AC Traveler
    4. Walk
29. Are you a U.S. Veteran?

    Optional. If you choose to answer, please respond with "yes" or "no."

33. Designation of Beneficiary

35. Name*

36. Phone*

38. Address*

39. Relationship*

43. Emergency Contact

45. Name*

46. Phone*

48. Address*

49. Relationship*

53. More about your interests

55. Preferred Locations

    All positions located in Anoka County; please specify if you’d like to only volunteer in a certain area of the county.

57. Other skills, interests, or limitations

    Please specify anything else you’d like us to know when matching you with volunteer opportunities. (Examples: professional skills you’d like to share in a volunteer setting; restrictions you want us to be aware of; etc.).

59. RSVP Volunteer Interests/Skills
    Please check the interest/skills that you have and would like to use as a RSVP volunteer. They will be entered in the RSVP skills bank and used to match volunteers to community needs. Based on your interests, you will be sent descriptions of volunteer opportunities to choose from. Training will be provided for all positions.

    Please check the interest/skills that you have and would like to use as a RSVP volunteer. They will be entered in the RSVP skills bank and used to match volunteers to community needs. Based on your interests, you will be sent descriptions of volunteer opportunities to choose from. Training will be provided for all positions.

61. Arts/Entertainment

    1. Arcenter Volunteer
    2. Gardening (Light)
    3. Nature Center Volunteer
    4. Photographer
    5. Theater

62. Basic Needs

    1. Prepare Clothing Donations
    2. Food Shelf Volunteer
    3. Food Shelf Driver
    4. Day Center Volunteer with Homeless Program (Weekdays, Weekends)
    5. Seqing/Quilting/Knitting
    6. Deliver Meals/Food
    7. On-line grocery order-taker
    8. Distribute recovered food (Manna Markets)

63. Education

    1. 4-H Club Project Leader
    2. Aging Mastery Program Instructor
    3. Assist as Local Public School
    4. Adult Education
    5. Adult Basic Education Tutor
    6. Cooking Matters Class Assistant
    7. Computer Lab Tutor
    8. English-as-Second-Language Tutor
    9. Home Work Help
    10. Health Insurance Counselor (Medicare)
    11. Tutor Connect

65. Health Services

    1. Bloodmobile Volunteer
    2. Hospital Volunteer
    3. Regional Treatment Center
    4. Coffee/Gift Shot Volunteer

66. History Center

    1. Carpenter
    2. Cataloger
    3. Performance Reader
    4. Photo Recorder
    5. Research
    6. Tour Guide/Walking Guide
    7. Special Events

67. Miscellaneous Support

    1. Advocate - Domestic Assault
    2. Childcare Assistant
    3. Kitchen Volunteer
    4. Mediation Volunteer
    5. Bicycle Repair
    6. RSVP Advisory Board Member

69. Office/Computer Support

    1. General Office/Clerical
    2. Grant Writer
    3. Database Manager
    4. Interviewer
    5. Answer Information Line
    6. Receptionist/Greeter
    7. Website Support

70. Senior Care

    1. Companion/Visit Senior at Caregiver's Home to Give Caregiver Time Off
    2. Assist at Group Respite Site for Caregivers and Care Receivers
    3. Adult Daycare Center/Nursing Home Volunteer

71. Short Term Projects

    1. Cleaning
    2. Fundraiser Events
    3. Handyman
    4. Mailing Projects
    5. Special Events

73. Tax Form Assistance

    1. Income Tax Preparation Volunteer
    2. Property & Mobile Tax Volunteer
    3. Electronic Return Originator (IT/Computer Experience Helpful)
    4. Tax Site Greeter

74. Transportation

    1. Deliver Meals/Food
    2. Drive Seniors or Veterans to Medical Appointments
    3. Recover school lunches or food from local stores

78. Signature
    Please check the confirmation box to confirm that you have read and understand the following statement: <br> • I hereby state that I am 55 years of age or older and offer my services as a volunteer for the Anoka County Retired Senior Volunteer Program. I understand that I am not an employee of the RSVP Project, the sponsor, Anoka County, the volunteer station, or the Federal Government and agree to serve without compensation.<br> • If I drive my own vehicle I will keep my automobile insurance updated.<br> • By enrolling in RSVP, I understand that my name and/or picture may be used in news stories, newsletters, news releases or slide presentations to help in promoting the Program.

    Please check the confirmation box to confirm that you have read and understand the following statement:
    • I hereby state that I am 55 years of age or older and offer my services as a volunteer for the Anoka County Retired Senior Volunteer Program. I understand that I am not an employee of the RSVP Project, the sponsor, Anoka County, the volunteer station, or the Federal Government and agree to serve without compensation.
    • If I drive my own vehicle I will keep my automobile insurance updated.
    • By enrolling in RSVP, I understand that my name and/or picture may be used in news stories, newsletters, news releases or slide presentations to help in promoting the Program.

80. Confirmation*

    1. I confirm

81. Your Full Name*

    Please enter your full name as an electronic signature

Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field