Retired and Senior Volunteer Program Survey

Background information on volunteer service and hours served

1. When did you begin volunteering with the Retired and Senior Volunteer Program?

Month _____

Year _____

2. How many days have you volunteered with the Retired and Senior Volunteer Program in 

the past month?

___ 0 days

___ 1 or 2 days

___ 3 to 5 days

___ 6 to 10 days

___ More than 10 days

3. How much time total would you say you’ve volunteered with the Retired and Senior 

Volunteer Program in the past month

___ 0 hours 

___ 1-10 hours 

___ 11-20 hours 

___ Greater than 20 hours

4. How much time total would you say you’ve volunteered with the Retired and Senior 

Volunteer Program in the past year

___ Less than 50 hours 

___ About 50 hours 

___ Between 50 and 100 hours 

___ About 100 hours

___ Between 100 and 200 hours 

___ About 200 hours

___ More than 200 hours

Volunteer Activities

5. What types of activities do you do in your service with the Retired and Senior Volunteer 

Program? [CHECK ALL THAT APPLY]

___ I provide companionship to or support other older adults or individuals with 

disabilities in staying in their own home. (Ask 5a)

___ I provide companionship to or support to older adults or individuals with 

disabilities living in group care situations. (Ask 5b)

___ I work with children or youths to build their academic skills (e.g. tutoring, 

assistance in classrooms, mentoring). (Ask 5c)
___ I work with youth or children to provide social support for children (e.g. 

comfort, and helping young mothers) (Ask 5d)

___ I provide basic educational services or support to adults. (Ask 5e)

___ I provide support services and information to veterans and/or military

families. (Ask 5g)

___ I work to prepare for or respond to emergency events. (Ask 5i)

___ I work with social service or volunteer agencies to build capacity and/or 

support other volunteers. (Ask 5j)

___ I serve in other ways. (Ask 5k)

5a. I am going to read a list of activities RSVP volunteers engage in when providing 

companionship to individuals staying in their own home. Please indicate if you have done any of 

these activities in the past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Helped clients with errands

Helped clients attend to personal 

and health care needs

Helped clients with jobs around 

the home

Delivered meals to clients

Made clothing for clients

Provided companionship

Provided information on health 

insurance or healthcare access

Provided translation services

Provided health education

Helped clients by driving them 

places

Assisted the station with 

organizational, outreach, or 

technology needs

Provided clients with 

companionship or emotional 

support

Staffed hotline

Developed/maintained 

community gardens

Distributed information

Provided financial literacy

Provided housing services
Distributed food

Collected food/Food pantry

support

Worked on Preventing Elder 

Abuse

Provided Training & Coaching

Distributed information

Other (Specify): _____

5b. I am going to read a list of activities RSVP volunteers do when providing companionship and 

support to individuals with disabilities living in group care situations. Please indicate if you have 

done any of these activities in the past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Helped clients with errands

Helped clients attend to personal 

and health care needs

Helped clients with jobs around 

the home

Delivered meals to clients

Made clothing for clients

Provided companionship

Provided information on health 

insurance or healthcare access

Provided translation services

Provided health education

Helped clients by driving them 

places

Assisted the station with 

organizational, outreach, or 

technology needs

Provided clients with 

companionship or emotional 

support

Staffed hotline

Developed/maintained 

community gardens

Distributed information

Provided financial literacy

Provided housing services

Distributed food

Collected food/Food pantry
support

Worked on Preventing Elder 

Abuse

Provided Training & Coaching

Distributed information

Other (Specify): _____

5c. I am going to read a list of activities that RSVP volunteers typically do when helping children

and youths improve their academic skills. Please indicate if you have done any of these activities 

in the past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Provided assistance in classroom

(including Head Start 

classrooms)

Provided tutoring (in general, or 

in public School or Faith-Based 

school)

Provided mentoring in school or 

other community settings 

Other (Specify): _____

5d. I am going to read a list of activities that RSVP volunteers typically do when providing

social support for children. Please indicate if you have done any of these activities in the past 

month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Provided comfort to children

Cared for infants

Helped young mothers

Other (Specify): _____

5e. I am going to read a list of activities RSVP volunteers typically do when providing basic 

educational or other support to adults. Please indicate if you have done any of these activities in 

the past month.

In the past month, have you Yes/No If yes, how many 
hours in the last 

month

Built & repaired homes

Provided assistance with housing 

search

Built or assisting homes- Habitat 

for Humanity

Provided Adult Basic 

Education/helped with GED/

Adult ESOL/ESL

Provided assistance with VITA

Provided income tax tutoring

Provided assistance with 

preventing elder abuse

Provided financial literacy

education

Other (Specify): _____

5g. I am going to read a list of activities RSVP volunteers typically do when providing services

to veterans and/or military families. Please indicate if you have done any of these activities in the 

past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Provided assistance to a DOL 

VETS Program

Provided support for Mental 

Health Access 

Provided support for Legal 

Assistance Access

Participated in activity

supporting veterans with 

disabilities and older veterans

Participated in activity

supporting veterans in rural 

communities

Participated in Economic 

Opportunity Activity that 

includes secure housing

Assisted veterans with 

transportation

Assisted with access to state and 

federal benefits

Provided other community-based 
activities that serve veterans and 

military families 

Participated in National Guard 

Volunteer Services

Provided coaching/counseling

Mentored military connected 

children

Provided referrals to services

Other (Specify): _____

5i. I am going to read a list of activities RSVP volunteers typically do when preparing for or

responding to emergency events. Please indicate if you have done any of these activities in the 

past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Created disaster kits

Performed outreach

Set up Call Centers

Staffed Call Centers

Transported victims

Set up shelter

Staff shelter

Provided Health/First Aid 

Services

Distributed meals

Clearing Debris

Renovating Housing

Providing Housing Transition 

Support

Cleared debris

Renovated housing

Provided housing transition 

support

Provided counseling

Participated in fire mitigation

Participated in tornado/hurricane 

mitigation

Other Disaster Mitigation

(Specify_ ___________

Assisted with disaster 

preparedness

Provided assistance with 
recovery

Other (Specify): _____

5j. I am going to read a list of activities RSVP typically do when assisting social service or

volunteer agencies build capacity to support volunteers. Please indicate if you have done any of 

these activities in the past month. 

In the past month, have you Yes/No If yes, how many 

hours in the last 

month

Recruited volunteers

Managed volunteers

Trained volunteers

Garnered donations

Provided support for Blood 

Drives

Collected food 

Food Pantry Support

Other (Specify): _____

5k. Are there any activities that you did in the past month as a RSVP volunteer that I did not 

mention?

Other ways in the past month 

(specify)

Yes/No If yes, how many 

hours in the last 

month

Demographics

6. In what month and year were you born?

a. Month

01. JAN

02. FEB

03. MAR

04. APR
05. MAY

06. JUN

07. JUL

08. AUG

09. SEP

10. OCT

11. NOV

12. DEC

98. Don’t Know

99. Refuse

b. Year _______________

9998. Don’t Know

9999. Refuse

7. Gender?

___ Male

___ Female

___ I prefer not to answer

8. Are you of Hispanic or Latino origin?

___ Yes

___ No

___ I prefer not to answer

9. What is your race? Please select one or more. 

___ White

___ Black or African American

___ Asian

___ Native Hawaiian or other Pacific Islander

___ American Indian or Alaska Native

___ I prefer not to answer

10. What is your Veteran Status [Check all that apply]

___ None, not a veteran

___ Active duty or Reserve Component

___ Military family

___ Veteran

___ Family of veteran

___ Don’t Know

___ I prefer not to answer
11. What is the highest grade or year of school or year of college you completed?

___ No formal education

___ Grades 1-11

___ Grade 12 (High School Diploma or GED)

___ Some College

___ Associate’s Degree

___ Bachelor’s Degree/College Graduate

___ Some graduate school

___ Completed a graduate/professional degree

___ Other

___ I don’t know

12. Are you currently married, with a partner as if married, separated, divorced, widowed, or 

never married?

___ Married

___ Have partner

___ Separated

___ Divorced

___ Widowed

___ Never Married

___ Other

Other volunteer services

13. How many hours did you spend per week in the past four weeks doing volunteer work 

for religious, educational, health-related, or other charitable organizations, not including 

your volunteer service with the Retired and Senior Volunteer Program?

___ 0 hours per week

___ 1-10 hours per week

___ 11-20 hours per week

___ Greater than 20 hours per week

Self efficacy 

14. I can do just about anything I really set my mind to. Do you agree or disagree with this 

statement? 

If disagree: Do you

___ Strongly disagree

___ Somewhat disagree or

___ Slightly disagree
If agree: Do you

___ Slightly agree

___ Somewhat agree or

___ Strongly agree

15. I can do the things that I want to do. Do you agree or disagree with this statement? 

If disagree: Do you

___ Strongly disagree

___ Somewhat disagree or

___ Slightly disagree

If agree: Do you

___ Slightly agree

___ Somewhat agree or

___ Strongly agree

Social Loneliness

16. How much of the time do you feel that you are alone? Would you say often, some of the 

time, or hardly ever or never [Check one] 

___ Often

___ Some of the time

___ Hardly ever or never

___ Don’t know

___ I prefer not to answer

17. How much of the time do you feel that you lack companionship? Would you say often, 

some of the time, or hardly ever or never [Check one]

___ Often

___ Some of the time

___ Hardly ever or never

___ Don’t know

___ I prefer not to answer

Emotional Loneliness

18. How much of the time do you feel that there are people you feel close to? Would you say

often, some of the time, or hardly ever or never [Check one] 

___ Often

___ Some of the time

___ Hardly ever or never

___ Don’t know

___ I prefer not to answer
19. How much of the time do you feel that there are people you can turn to? Would you say

often, some of the time, or hardly ever or never [Check one] 

___ Often

___ Some of the time

___ Hardly ever or never

___ I don’t know

___ I prefer not to answer

Employment and Retirement

20. Are you working now, temporarily laid off, unemployed and looking for work, disabled 

and unable to work, retired, a homemaker, or what? [Choose all that apply]

___ Working now

___ Unemployed and looking for work

___ Temporarily laid off, on sick or other leave

___ Disabled

___ Retired

___ Homemaker

___ Other (Please Specify) _____

___ I don't know

___ I prefer not to answer

20a. (If laid off) In what month and year were you laid off?

Month _____

Year _____

20b. (If unemployed) In what month and year did this period of unemployment 

start? 

Month _____

Year _____

20c. (If retired) In what month and year did you retire?

Month _____

Year _____

20d. (If retired) Thinking back to the time you [partly/completely] retired, was 

that something you wanted to do or something you felt you were forced into? 

[Check one]

___ Wanted to do

___ Forced into

___ Part wanted, part forced

___ I don't know

___ I prefer not to answer

Volunteer Experience
21. Do you agree or disagree with this statement: My RSVP volunteer work is a good match 

for my skills?

If disagree: Do you

___ Strongly disagree

___ Somewhat disagree or

___ Slightly disagree

If agree: Do you

___ Slightly agree

___ Somewhat agree or

___ Strongly agree

22. Do you agree or disagree with this statement: My RSVP volunteer work is interesting? 

If disagree: Do you

___ Strongly disagree

___ Somewhat disagree or

___ Slightly disagree

If agree: Do you

___ Slightly agree

___ Somewhat agree or

___ Strongly agree

23. Do you agree or disagree with this statement: My RSVP supervisor provides me with the 

support and information I need to serve? 

If disagree: Do you

___ Strongly disagree

___ Somewhat disagree or

___ Slightly disagree

If agree: Do you

___ Slightly agree

___ Somewhat agree or

___ Strongly agree

Additional information about volunteer experience

24. What else would you like us to know about your RSVP volunteer service?

25. Is there anything else you would like to let us know?