First Name *
Last Name *
Current Address *
City *
Zip Code *
Previous Address (if less than 2 years at current address)
Email Address *
Phone Number *
Use this format: ###-###-####
Date of Birth *
You must be 55 years of age or better to qualify for the RSVP program.
MM
/
DD
/
YYYY
Gender
Clear selection
Ethnicity
Veteran *
Emergency Contact (Name & Phone Number): *
How did you hear about Cultivate/RSVP? *
If referred, who can we thank for telling you about us?
Why would you like to volunteer?
Supplemental Insurance & Mileage Reimbursement
As a Cultivate RSVP volunteer, you are covered by supplemental 1) accidental insurance, 2) liability insurance, and 3) excess automobile insurance while volunteering in the program.

Attention: By providing the following insurance and driver’s license information the applicant understands that he/she will be covered by Cultivate’s free supplemental insurance policy for volunteers.
Are you interested in the supplemental insurance? *
If yes, please fill out the beneficiary information below.
Beneficiary Name
Relationship
Beneficiary Phone Number
Use this format: ###-###-####
Beneficiary Address
Full address including City and State
Background Check
I understand that background checks may be made by the participating RSVP Partner Agency and it is at their complete discretion.
Type in your initials to confirm acceptance of the Background Check Policy. *
Volunteer Agreement
I volunteer my services through Cultivate and agree to furnish information regarding volunteer activities and hours. I also affirm that the above information is accurate and complete to the best of my knowledge.
Electronic Signature
To confirm agreement with the statement listed above, type your first and last name. Submitting this form constitutes your electronic consent in place of a physical signature. If you have questions about anything listed on this form, contact Carly Marquis, Volunteer and Outreach Manager, at 303.443.1933 x406.
To confirm agreement type your full name as your signature *
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