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AmeriCorps Senior Application

Connect. Serve. Make a Difference.

Through AmeriCorps Seniors, Senior Resources offers two meaningful volunteer opportunities designed to strengthen our community across generations.

As a Foster Grandparent, you’ll mentor and support children who need extra encouragement—helping them build literacy skills, confidence, and brighter futures in partnership with local schools and community organizations.

As a Senior Companion, you’ll provide friendship and connection to older adults who want to remain independent at home—reducing isolation and giving family caregivers valuable time to rest and recharge.

Whether you feel called to support a child’s growth or help a senior stay connected and independent, your time and compassion can make a lasting impact.

Complete the form below to learn more and get started.

AmeriCorps Senior Application

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This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Birthdate(Required)

Phone Number(Required)

Social Security(Required)

Veteran?

Yes

Marital Status

Single

Married

Divorced

Widowed

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Transportation(Required)

Personal Car

Public Transportation

Other – Specify below

Education(Required)

Some High School

High School Graduate

Some College

College Graduate

Transportation – other

Are you interested in serving as a Foster Grandparent?(Required)

Yes

Are you interested in serving as a Senior Companion?(Required)

Yes

If yes, why?

How did you hear about the AmeriCorps volunteer program?

Current or past Foster Grandparent volunteer

Current or past Senior Companion volunteer

Senior Resources client

Senior Resources staff member

Poster or Brochure

Newspaper

TV or Radio

Community Event – Specify below

Other – Specify below

Community event or other

Name of person or business who referred you

Employment Experience

Hobbies and Special Skills

Memberships in Clubs and Organizations

Volunteer Experience

How would you describe your health?

Excellent

Good

Fair

Poor

Do you require any accommodations? Do you have physical or medical considerations that may impact a volunteer assignment?

Yes

If yes, please explain

What days and hours are you available? Select all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

Mornings

Afternoons

Please provide two personal references who are not family members

Reference 1 Name(Required)

Reference 1 Relationship to you(Required)

Reference 1 Phone Number(Required)

How many years have you known reference 1?(Required)

Reference 2 Name(Required)

Reference 2 Relationship to you(Required)

Reference 2 Phone Number(Required)

How many years have you known reference 2?(Required)

Eligibility to be a volunteer is based on your gross total household income. Please list sources of projected income for the next 12 months. Proof of income for each legally mandated person living in your household is required to be returned with this application.

Number of persons living in your home, including you

Provide your MONTHLY income amounts. Put N/A if there is no income for a category. If you need to provide income for more than 3 people, please bring it to our office at 2817 Millwood Ave. Columbia, SC 29205 Monday-Friday 8am-4pm or email to acs@seniorresourcesinc.org

Applicant: Social Security(Required)

Applicant: SSI(Required)

Applicant: Annuity Income(Required)

Applicant: Pension Income(Required)

Applicant: Rental Income(Required)

Applicant: Stocks and Bonds(Required)

Applicant: Wages or Salary(Required)

Applicant: Veteran's Income(Required)

Applicant: Other(Required)

Person 1: Social Security(Required)

Person 1: SSI(Required)

Person 1: Annuity Income(Required)

Person 1: Pension Income(Required)

Person 1: Rental Income(Required)

Person 1: Stocks and Bonds(Required)

Person 1: Wages or Salary(Required)

Person 1: Veteran's Income(Required)

Person 1: Other(Required)

Person 2: Social Security(Required)

Person 2: SSI(Required)

Person 2: Annuity Income(Required)

Person 2: Pension Income(Required)

Person 2: Rental Income(Required)

Person 2: Stocks and Bonds(Required)

Person 2: Wages or Salary(Required)

Person 2: Veteran's Income(Required)

Person 2: Other(Required)

Do you currently receive any of the following? Check all that apply

Medicare

Medicaid

SSI

Date(Required)

AmeriCorps Senior Application

Connect. Serve. Make a Difference.

AmeriCorps Senior Application

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