RSVP Larimer County Enrollment Form

Thank you for your interest in RSVP! Please complete the information below and one of our Sr. Associates will contact you with next steps.

"*" indicates required fields

First Name*

Last Name*

Email*

Street 1*

Street 2

City*

State*

Zip Code*

Phone*

Month*

Date*

Year*

Gender*

Are you an actively serving or veteran member of the armed forces?

Is a family member (spouse, parent, child) actively serving or a veteran member of the armed forces?

Ethnicity (Optional)

Race (Optional)

How did you hear about AmeriCorps Seniors - RSVP?*

Volunteers of America website

United Way or Volunteer Match

Internet

Newspaper

Volunteer Fair or Presentation

Current Volunteer Position

Another Volunteer

Do you currently volunteer anywhere? Please list all agencies you serve with if so.*

What do you do in your current volunteer role?

Please share what population or type of volunteer work is most appealing to you.

AUTO INFORMATION: (If you do not complete this section, you will not receive supplemental Auto Liability Insurance). Please list your Driver's License #, State and Expiration

Colorado requires that all drivers have auto insurance and a valid driver's license to operate a motor vehicle. I do and will continue to comply with the Colorado State Law that requires all drivers to have a valid Colorado Driver's license and minimum automobile insurance.

ACCIDENTAL DEATH BENEFICIARY: (Required for all AmeriCorps Seniors Enrollees for free benefit purposes). Please list the Beneficiary Name, Relationship, Address, and Phone Number.

Solutions

Americorp Senior RSVP

Community Support Services

Food & Nutrition Services

Housing & Emergency Services

Veteran Services

Solutions

Community Support Services

Food & Nutrition Services

Housing & Emergency Services

Veteran Services

Solutions

Community Support Services

Housing & Emergency Services

Veteran Services

Solutions

Community Support Services

Housing & Emergency Services

Veteran Services

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