Foster Grandparent Program Application

**Please complete all sections. Forms with original signatures are required for enrollment** 

For additional questions or concerns, please call: 828-438-6255 or email snelson@brcainc.org

FGP provides a mileage reimbursement for travel between home and volunteer site to the volunteers.

As a FGP volunteer, you will be covered by accident and personal liability insurance plus a small death benefit while performing volunteer duties. This coverage is automatic and free of cost to you as long as you are an active, enrolled member of FGP. Please provide the following information on the remaining pages.

Beneficiary for FGP Supplemental Accident Insurance:

The following information will help FGP match you with a volunteer opportunity:

Certifications

By signing below, I acknowledge that I have read and understand the following statements:

• I hereby state that I am 55 years of age or older and offer my services as a volunteer for the BRCA Foster Grandparent Program. I understand that I am not an employee of the FGP Project, the sponsor, BRCA, the volunteer station or the Federal Government.
• I understand that in my capacity as an FGP volunteer I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.
• I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of North Carolina. I will also keep in effect a valid NC Driver License.

Equal Employment Agency. BRCA FGP is an equal opportunity agency. Enrollment is done without regard to race, color, national origin, gender, sexual orientation, religion, age, disability, political affiliation, marital or parental status, or military service. FGP provides reasonable accommodations to the known disabilities of individuals in compliance with the Americans with Disabilities Act. For accommodation information or if you need special accommodations to complete the application process, please contact BRCA FGP at (828) 438-6255

 

For questions or futher information contact:

Serena Nelson
(828) 438-6255, Ext 441

 

I certify that to the best of my knowledge all income has been stated for the next 12 months and is correct. Also, I have read the above statements and hereby agree.

The following information is optional and will not affect you enrollment with BRCA FGP

1. Occasionally, BRCA FGP will purchase volunteer recognition gifts for FGP members. Please share the size you would use on each item below.