Resource Inventory

Name_______________________________________________________

Address______________________________Phone__________________

City___________________State__________________Zip_____________

Year Retired__________ Last Position Held__________________

Birthday_____________________________________

I. ISSUES OF INTEREST

In the spaces below please check your specific interests: _____Conservation _____Health Insurance _____Environment _____Transportation _____National Politics _____Education _____International Politics _____Poverty _____World Issues _____World Cultures _____Hunger _____Local Cultures _____Peace _____Economic Issues _____Housing _____Continuing Interest in Your Former Profession _____Child Care _____Other _____Elder Care

II. ABILITIES

In the items below please check your specific interests/skills and add appropriate "others."

____Reading to ____Teaching a ____Tutoring Special Groups Short Course

____Mentoring ____Guest Lectures ____Writing

____Editing ____Word Processing ____Interviewing

____Listening ____Counseling ____Guardianship

____Managing ____Sign Language ____Braille Household Affairs

____Foreign Language ____Computers ____Statistics

____Data Analysis ____Budgeting ____Bookkeeping

____Gathering ____Cataloging ____Organizing Information

____Promoting Ideas ____Recruiting Others ____Motivating Others

____Problem Solving ____Fundraising ____Managing

____Designing ____Sculpture ____Photography Exhibits/Poster

____Music ____Sports ____Organizing Games

___Exercise

___Other (Specify)_____________________________________________ ________________________________________________________________________________________________________________________

III. HOBBIES (Check hobbies of interest to you)

_____Hunting _____Fishing _____Swimming _____Stamp Collecting _____Photography _____Antique _____Coin Collecting _____Car Repair _____Genealogy _____Cooking _____Car Restoration _____Weaving _____Knitting _____Furniture Needlework Restoration _____Woodworking _____Gardening _____Flowers _____Dramatics _____Reading _____Playing Cards _____Camping _____Walking/ _____Traveling Hiking _____Golf _____Singing _____Tennis _____Dancing _____Other

IV. Do you prefer to work with certain age groups:

Babies______________ Preschool____________ High School__________ College Students______ Adults_______________ Older Adults__________

V. AVAILABILITY/SCHEDULE FOR POSSIBLE VOLUNTEER ACTIVITY:

A. I may be most available:

1. Weekdays:_____Morning_____Afternoon_____Evening

2. Weekends:_____Morning_____Afternoon_____Evening

3. Seasons: Fall ___ Winter____ Spring ____ Summer____

B. My transportation situation: (Circle the statement that applies.)

_____. I can provide my own transportation.

_____ I rely on others for transportation.

This VOLUNTEER SURVEY has been developed jointly by the SIU Emeritus College, the Annuitants Association, AARP, Retiree Mentoring Commission, and was coordinated by the Illinois Intergenerational Initiative We appreciate your cooperation in filling out this form.

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Intergenerational Initiative