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

    Check all that apply

  • Contact Information

  • 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.
    Check all that apply
    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.
  • Please list anything you think is relevant
    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
  • Please enter how you know the reference. Generally references should not be family members.
  • Please enter how you know the reference. Generally references should not be family members.
  • Please enter how you know the reference. Generally references should not be family members.