RSVP Program Partner Agency Application
Agency Information
Agency Name:
Mailing Address:
City:
State:
Zip:
County:
Business Phone:
Fax:
Contact Person:
Role/Position:
Email Address:
Website:
Please select which of the following best describes your organization:
Public or Private Non-Profit Organization
Proprietary Health Care Facility
Governmental or Public Agency
Other:
Mission Statement:
Focus Areas and Position Descriptions
The RSVP Program is primarily focused on providing volunteers to serve in the following areas.
However, we do recruit a percentage of our volunteers to serve in other community priorities.
Please indicate in which of the following areas you have opportunities for RSVP volunteers.
Assistance/Companionship/Transportation
Nature/Environment
Veterans
Sustainability
People with disabilities
Maintaining Trails/Waterways
Elderly
Capacity Building & Community Leadership
Nutrition Services
Advisory Council
Food Bank Assistance
Volunteer Coordination & Recruitment
Meals on Wheels
Planning Events/Fundraising
School/Community Gardens
Program Outreach
Education
Veterans and Military Families
Literacy/Tutoring
Adult Veterans
Children
Adults
Children/Military Families
Career/Life Skills Classes
Other Community Priorities (please list):
Our agency serves approximately
clients annually? We track that information through…:
The impact we have on the community is:
If we are selected as an RSVP Partner Agency, we agree to do all of the following:
Report RSVP volunteer’s hours on a monthly basis.
Provide written position descriptions for each position you are seeking RSVP volunteers to fill.
Attend an annual training with RSVP staff.
Provide report data to RSVP staff such as impact statements and annual satisfaction surveys.
We can provide the following In-Kind Contributions to the RSVP volunteers:
Meals
Mileage
Background Check/Fingerprinting
Uniform
Use of Services
Other:
Please return the completed application to:
Partner Agency Representative Signature:
____________________
Date:
Title:
Program Coordinator Signature:__________________________________ Date:____________
FOR OFFICE USE ONLY:
ENROLLMENT DATE: ______________________
DIRECTOR SIGNATURE: ___________________
Updated 10/9/13