RSVP Application

Applicant Information
Upload requirements
Upload requirements
Emergency Contact

As a volunteer of RSVP, you will be covered by accident, personal liability and excess automobile insurance plus a small death benefit while performing volunteer duties.  This coverage is automatic and free of cost to you as long as you are an active, enrolled member of RSVP.  Please provide the following information.


Beneficiary for RSVP Supplemental Accident Insurance:

Employment Information
Hours available

Please indicate if RSVP may have permission to use your likeness:

By signing below, I acknowledge that I have read and understand the following statements:

  • I hereby state that I am 55 years of age or older and offer my services as a volunteer for the Lackawanna, Luzerne and Wyoming Counties Retired and Senior Volunteer Program (RSVP).  I understand that I am not an employee of the RSVP Project, United Way of Lackawanna and Wayne Counties, Lackawanna County, the volunteer station or the Federal Government and agree to serve without compensation.
  • I understand that in my capacity as an RSVP volunteer I may come in contact with confidential information.  I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.
  • I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Pennsylvania.  I will also keep in effect a valid Pennsylvania Driver's license.

Equal Employment Agency - RSVP is an Equal Opportunity Agency.  Enrollment is done without regard to race, color, religion, national origin, sex, age or disability.  RSVP provides reasonable accommodations to the known disabilities of individuals in compliance with the American with Disabilities Act.  For accommodation information or if you need special accommodations to complete the application process, please contact RSVP of Lackawanna, Luzerne and Wyoming Counties at 570.343.1267 x312


Demographic Information (Optional)

RSVP is often asked to provide demographic information pertaining to volunteer members.  Please provide the following information (Optional):

Thank You for all of the information you provided.  Your information is NEVER sold, shared or used outside of RSVP of Lackawanna, Luzerne and Wyoming Counties or the Corporation of National Community Service.