Submit Your Missouri SHIP Volunteer Application

You've submitted your interest form, gotten more information, and you're ready for the next step!

Please fill out the volunteer application below. If you have questions, the Regional Liaison or other staff member who sent you the form will be happy to answer!

Missouri SHIP Volunteer Application

"*" indicates required fields

How did you hear about Missouri SHIP?*
Check all that apply

Contact Information

Mailing Address*
Address Type*
Phone Type*
Phone Type
Email type*

Demographic Information:

The Administration for Community Living (ACL) REQUIRES SHIP programs to collect this information, as it is used for a required Resource Report. As part of our grant funding, we collect demographic information about our volunteers. This information will be kept confidential and will not be used to make a determination about your volunteer application.
Race/Ethnicity*
Check all that apply
Gender*
Check all that apply

Work History and Experience:

Missouri SHIP volunteers cannot work for insurance companies, have an insurance license and/or sell insurance for at least one year prior to volunteering. A person cannot potentially receive any financial gain from becoming a Missouri SHIP volunteer counselor.
Are you currently working in the insurance industry?*
Have you worked in the insurance industry within the past 12 months?*
Please list anything you think is relevant
Are you fluent in any language other than English (including sign language)?*
Can you make a minimum commitment of eight (8) hours per month?*
Have you ever been convicted of a felony?*
An answer of “Yes” is not an automatic disqualification. A background check will be completed during training.

References:

Please list three references who are not family members
Reference 1: Name*
Please enter how you know the reference. Generally references should not be family members.
Reference 2: Name*
Please enter how you know the reference. Generally references should not be family members.
Reference 3: Name*
Please enter how you know the reference. Generally references should not be family members.