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Volunteer Form

Thank you for your interest in the Senior Medicare Patrol volunteer program. As a volunteer, you will play a vital role in the overall success of the Wisconsin SMP. The information that you will impart as a volunteer will be key to helping seniors in your community to become better health care consumers. Together we can inform and empower Medicare beneficiaries, their families and caregivers on how to protect, detect, and report Medicare fraud, abuses and errors. By volunteering, you will have an opportunity to use your talents, skills and networking to provide outreach and education on Medicare fraud in your community. Your volunteer involvement can range from distributing materials, staffing a booth, to giving presentations. A description of these three activities is below.

SMP Volunteer Roles

All positions require some training and an orientation. Training is provided both in-person and online. We want to provide you with the information and background you’ll need to be knowledgeable and capable of responding to questions from members of the community. These latter two roles also require a background check.

Benefits of servings as an SMP Volunteer

The SMP program offers volunteers an opportunity to make an important difference in their communities. Volunteers take pride in working to ensure that the Medicare program will be protected for future generations. Volunteers have access to professional development opportunities, a strong network of aging and disability professionals, and chances to enhance interpersonal skills.

Time Commitment

SMP Volunteers have flexibility in the time devoted to the program. While there is not an obligation for a specific monthly time commitment, it is asked that volunteers commit to at least a year due to the amount of training required.


Volunteers report directly to the SMP Volunteer Coordinator and submit monthly time sheets and mileage reports.


Responsibilities and Requirements

Volunteers are an asset to our program and play a major role of the organization’s success. Please join our growing team of SMP volunteers from across the state!


About the Volunteer Application & Screening Process

  1. What are the steps in the application and screening process?

    At a minimum, the process requires a completed application form and an interview. Depending on the role, the screening process may also include two reference checks, a criminal records check, driving records check, and checks on education or employment background.

  2. Why are there so many steps in the process?

    The SMP program takes seriously the safety of the program’s beneficiaries and volunteers. Many of the people who use the program’s services are in a vulnerable position due to illness, infirmity, and dependence. A thorough screening process enables the program to maintain a safe and productive community service program with trustworthy and reliable volunteers who do not present a risk of harm to themselves and others.

  3. Who reviews my application form?

    The coordinator of volunteers and anyone who participates in your interview will review your application form.

  4. Why do you ask about conflicts of interest on the application form?

    The program strives to provide objective and unbiased information and services involving Medicare and other health insurance programs. Objectivity is important to building trust with individuals and a reputation of trustworthiness in the community. To build a volunteer workforce that provides objective information and services, we ask applicants to declare if they have a financial, personal, or philosophical interest that may present a conflict with the program’s interest in maintaining its reputation for objectivity.

  5. Why do you check references and conduct a criminal records check (for some positions)?

    These types of checks are conducted for volunteer roles that we deem “positions of trust,” meaning they involve access to clients or client personal information (see the SMP Volunteer Roles handout included in this packet). We check at least two personal and/or work references because they provide relevant information for the managers who make the acceptance and placement decisions. We also check criminal records to ensure the safety of SMP. We will inform you of the screening steps required for the position for which you have applied and conduct them only with your consent.

  6. What will you do with the sensitive personal information that I provide?

    At a minimum, the process requires a completed application form and an interview. Depending on the role, the screening process may also include two reference checks, a criminal records check, driving records check, and checks on education or employment background.

  7. How will I learn if I have been accepted for placement as an SMP volunteer?

    You will receive a letter that notifies you of our decision. If we accept you for placement, the letter will also inform you about orientation and training program for new volunteers.

  8. How long does the screening process take?

    The length of time may vary depending on our ability to schedule an interview, the availability of references to take calls and answer questions, and the response time of authorities who conduct driving records checks and criminal records checks. The process could take 3 weeks. We will update you if the process takes longer than we expect.

The steps to becoming a valued member of the SMP volunteer team

  • Contact Information

  • Required to enter volunteer into the SMP Resource Center.
    If you will be driving to and from SMP events, you will need to provide a copy of your driver’s license and insurance. This information will be collected after the orientation. To ensure the safety of our volunteers and the communities we serve, all potential SMP volunteers will be asked to provide information for a background check.
  • Emergency Contact

  • Interest in SMP Program

  • Conflicts of Interest

  • Work/Volunteer History

  • If you are currently employed, please list your current job. If not currently employed, please list your most recent job.
  • Demographics (Optional)

    This section is used to determine if our recruitment efforts are reaching all segments of the population. Your voluntary responses are used for statistical purposes only and will not affect your application.
  • Other

  • Reference

    Please provide a professional or personal reference we may contact regarding your qualifications.
  • (e.g., Sister, Neighbor, Supervisor – Note: If professional, list organization)
  • Volunteer Self-Assessment of Skills and Interests

    Directions: Review the following list of common roles performed by SMP volunteers and rank the three choices based on your interest in performing each type of work. Enter 1 through 3 in the rank field and explain why it interests you in the field to the right.
  • Signature

  • I hereby authorize the Wisconsin SMP to solicit a reference from the above-named reference contact in connection with my application for the position of SMP volunteer. I hereby authorize the above-named reference contact to provide a reference in connection with my application for the position of SMP volunteer and release them from any liability in regard to the same. I certify that all information given or referred to in this application is true, complete, and correct to the best of my knowledge.