Volunteer Enrollment Form

"*" indicates required fields

Step 1 of 3

Name*

Legal First Name

Preferred First Name

Middle Name

Last Name

Address*

Street Address City State ZIP Code

Best Phone*

Type*

Cell

Home

Work

Alternate Phone

Type

Cell

Home

Work

Email address

(If you do not have an email address you will be contacted via phone or US Mail)

Birthday*

Month

Day

Year

Age*

(Must be 55 or older)

Gender*

Male

Female

Ethnicity/Race*

African American

Asian American

European/White

Latino/Hispanic

Native American/Alaskan Native

Pacific Islander/Native Hawaiian

If you are proficient in a language other than English, please list here:

Are you a military service veteran?*

Yes

In case of emergency, please notify:

Name*

First Last

Relationship*

Phone*

I give RSVP of North Central Iowa permission to use my photo related to volunteer activities in its newsletter, press releases, other publications, Facebook, and website.*

Yes

Please choose your preferred way to receive the RSVP newsletter*

US Mail

Confidential Information*

I understand that in my capacity as an RSVP Volunteer, I may be exposed to confidential information. I will protect this information to the best of my ability and not disclose it during or after my service.

Step 1. Check the box below*

By checking this box and typing my name below, I am electronically signing my enrollment form.

Step 2. Type in your name*

First Middle Initial Last

Today's Date*

MM slash DD slash YYYY

Please tell us a little bit about yourself:

How did you learn about RSVP?

RSVP Volunteer

Newspaper

Facebook/Social Media

Other

RSVP Volunteer Name*

Name of Newspaper*

Previous occupation/work experience/skills/interests/volunteer experience:

Why do you want to volunteer with RSVP?

What do you hope to give and gain from your volunteer experience?

RSVP Volunteer Opportunities

Please indicate the program(s) and location(s) where you want to volunteer

The following are volunteer opportunities in area elementary and middle schools – these programs are coordinated by RSVP:

Breakfast Buddy:

Mentoring program at the school-sponsored breakfast

Forest City Elementary School

Pen Pal:

Connecting volunteers with 4^th - and 5^th -grade students through monthly letter-writing

Britt – West Hancock Elementary School

Clear Lake – Clear Creek Elementary School

Forest City Elementary School

Garner – Garner-Hayfield-Ventura Elementary School

Hampton – Hampton-Dumont Middle School

Mason City – Harding, Hoover, Jefferson, Lincoln, Roosevelt schools

Osage – Lincoln Elementary School

Reading Buddy:

Literacy tutoring program for elementary school students

Britt – West Hancock Elementary School

Buffalo Center – North Iowa Elementary School

Clear Lake – Clear Creek Elementary School

Forest City Elementary School

Garner – Garner-Hayfield-Ventura Elementary School

Hampton - HD Northside Elementary School

Lake Mills Elementary School

Latimer – CAL Elementary School

Mason City – Harding Elementary School

Mason City – Hoover Elementary School

Mason City – Jefferson Elementary School

Mason City – Newman Catholic Elementary School

Mason City – Roosevelt Elementary School

Manly – Central Springs Elementary School

Nora Springs – Central Springs Elementary School

Northwood – Northwood-Kensett Elementary School

Osage – Lincoln Elementary School

Riceville – Riceville Elementary School

Rockford - Rudd, Rockford, Marble Rock

Rockwell – West Fork Elementary School

St. Ansgar – St. Ansgar Elementary School

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Substitute

For any of the above-checked sites, please consider me a substitute only

Reading Coach:

Literacy tutoring and mentoring program for middle school students

Forest City Middle School

Hampton – Hampton-Dumont Middle School

Mason City – Lincoln Intermediate School

The following are volunteer opportunities with partnering agencies in the six-county RSVP service area – volunteers are still considered RSVP Volunteers:

American Red Cross:

Assist with blood drives at registration table or canteen (Cerro Gordo, Franklin, Hancock, Mitchell, Worth, and Winnebago)

Cerro Gordo County Disaster/Emergency:

Serve during disasters or emergencies

Phone Bank Operator

Volunteer Reception Center

International Friend:

Befriend an international student at NIACC

IRIS – Iowa Radio Reading Information Service for the Blind and Print Handicapped:

Read the Globe Gazette on the air at KCMR radio station in Mason City

Jail & Prison Ministry:

Mentoring program offering a Circle of Support and Accountability for ex-offenders through Catholic Charities.

Usher:

Assist with the shows of the NIACC Performing Arts & Leadership Series

VITA – Volunteer Income Tax Assistance:

Tax preparation assistance program

Garner

Hampton

Mason City

Osage

Northwood

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Volunteer Enrollment Form

Please tell us a little bit about yourself:

RSVP Volunteer Opportunities