RSVP Application

General Information

First Name *
Last Name *
Phone *
Email *
Address *
City *
State *
Zip *

Volunteer Data Record

The funding source requires reports that identify volunteers sex, race, age, handicapped and/or veteran status. In order to comply with necessary reporting, record-keeping and other requirements, please complete this Volunteer Data Record.

This information maye be used to determine other (GECAC) programs that may benefit you.

Submission of information is voluntary and is not a condition of acceptance.

Date of Birth
Age Group
Marital Status
Any Physical Limitations
If yes, please describe
Groups of individuals you prefer to work with *
Select all that apply.
Please identify all areas of interest
Select all that apply.


How will you travel to and from your volunteer workstation?
Driver License No.
8 Digits
Expiration Date

I understand that if I use my personal vehicle in traveling to and from volunteer activities, I must have, and keep in affect, auto insurance equal to the minimum limits required by the State of Pennsylvania.

I acknowledge that I have read and understand the above statement

Emergency Contact

Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Relationship
Emergency Contact Phone
Emergency Contact Address
Emergency Contact City
Emergency Contact State
Emergency Contact Zip
Referred to RSVP by