RETIRED AND SENIOR VOLUNTEER PROGRAM, NEW CASTLE COUNTY
Volunteer Entrance Form

Name (Mr., Mrs., Ms.):
Address:

Phone:                                               Birth Date (mo/day/yr):
Social Security Number:
Driver’s License Number:
Person to notify in case of emergency:
Relationship:                                              Phone:
Physician’s Name:					   Phone:

Do you have a physical/medical disability?  
* Yes
* No

If "yes", what is the nature of the disability? 

How did you hear about RSVP?  (check all that apply)
* Friend
* Newspaper
* Radio/TV ad
* Brochure/Poster
* Community Agency
* Other
Education and Training:

Previous Work or Occupation:


Would you rather work:
* with people (examples: mentoring, friendly visiting, teaching, etc.)
* with things (ex.: office work, sorting food, shelving books, etc.)

If you prefer to work with people, what groups would you be most interested in working with? (check all that apply)
____Babies                                   ____ Adults with Disabilities
____Children                                 ____ Other:
____Teenagers
____Young Adults
____Adults
____Children with Disabilities

Do you have a unique talent or skill that you’d like to share? (e.g., language, professional skill, hobby, etc.)


Beneficiary for RSVP Supplemental Accident Insurance
Name:

Address:

(In order to keep statistics on volunteer trends, we would appreciate you providing us with the information listed below.  Completion of the section below is optional.)

Ethnicity:
* American Indian
* Black
* Asian/Pacific Islander
* Hispanic
* White
* Unknown

Volunteer’s Signature                                                    Date


RSVP Coordinator’s Signature                                             Date


Retired and Senior Volunteer Program, New Castle County
1901 N. DuPont Highway, Debnam Bldg., New Castle, DE 10720
Phone: 255-9882

RSVP  is sponsored by the State Office of Volunteerism, Division of State Service Centers, 
Delaware Health and Social Services.


SKILLS AND TALENTS

Please circle the code next to the skill or skills you would like to use in volunteering.


CODE		SKILL				CODE		SKILL
AN1		Animal Skills			HO1		Gardening
AR3		Art/Calligraphy			HOS		Ushering
AR2		Performing Arts			HSK		Housekeeping
AR1		Visual Arts			MU3		Musical Instrument
AV3		Audio/Visual			LN2		Interpretation
BS2		Business/Accounting		LN1		Translation
BS1		Retail Sales			LEA		Leadership Skills
CL2		Bulk Mailing			LEG		Legal/Law Enforcement
CL1		General Clerical		LIB		Library Skills
CM4		Fundraising			MUS		Museum Skills
CM1		Graphic Design			MU1		Music/Singing
CM3		Public Speaking			NG1		Nature Guide Skills
CM2		Writing/Editing			NU1		Nutrition/Cooking
CO1		Coordinating			NU2		Nutrition/Serving
CR1		Craft/Knit/Crochet		RES		Research Skills
CR2		Craft/Sew/Needlework		SOR		Sports/Processing
CR3		Crafts-General			REC		Sports/Recreation
MU2		Dancing				SC1		Senior Center
DRV		Driving				TH1		Teaching/Aide
FR3		Counseling			TH3		Teaching/Group
FR2		Friendly Visiting		TH4		Teaching/Reading
HE2		Health/First Aid		TH2		Teaching/Tutoring
HE5		Health/Hospital General		TE1		Technical/Chemical
HE3		Health/Instruction		TE5		Technical/Computer
HE4		Health/Patient Care		TE2		Technical/Engineer
HE1		Health/Professional		TE3		Technical/Repair
HO2		Flower Arranging		TE4		Technical/Scientific
THE		Theater General			TG1		Tour Guide Skills



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