Skip to main content

Success Coach Volunteer Application

Please complete the information below to secure your spot as a volunteer success coach.

  • Your application must be completed and submitted in one session. If you navigate away from the page, your progress will not be saved.
  • Please do not complete the application in ALL CAPS or all lower case. 
  • Fields marked with a red asterisk (*) are required and must be completed in order for your application to be submitted. 


  • You are applying to be a coach for the next four month session starting Wednesday, February 5, 2020.  Training will be provided before that date.
  • Attend one orientation/training session at Veterans Outreach, 1624 Yout St., Racine.
  • Lead a bi-weekly, 30-minute coaching session for a minimum of four months (eight sessions total). At the end of the four months, you will have the opportunity to renew for another four months.
  • All coaching sessions are scheduled and coordinated between the coach and the client. Sessions are held at Veterans Outreach.
  • Attend monthly coach meetings by phone.

Background Check

  • All volunteers must consent to and pass a background check conducted by the Racine County Sheriff's Department.
    • Volunteers who do not pass the background check will be notified and will not be placed in a volunteer assignment.


Contact Lori Riffer, financial stability manager, at 262-456-6468.

Volunteer information
The information below is necessary in full detail as we are required by law to conduct a background check on all applicants of the success coach program.
You may select more than one option.
Include full address (city, state and zip).
Providing a secondary email is optional. Leave this field blank if you do not have a second email address.
Interest in Success Coaching
If retired, most recent employer
New success coach volunteers must complete a one time orientation/training session at Veterans Outreach.
Emergency contact information
The information that you provide in this section will be provided to the site where you volunteer so that they know who to contact on your behalf in the event of an emergency.
Please list any medical conditions (high blood pressure, diabetes) or allergies (bee stings, nuts) that would be pertinent in an emergency situation.
Please be sure to check both boxes below, or your application will not be submitted successfully.
I authorize the investigation of all statements contained herein and understand that any document relevant to this information may be reviewed by the agents of United Way of Racine County. I understand that I may not begin volunteering until the background investigation has been completed. If accepted as a volunteer, I understand that I will be expected to keep in absolute confidence any and all confidential information that comes to my attention as the direct result of my volunteer duties. I certify that the answers given by me in this disclosure statement are complete, true, and correct without misrepresentations or omissions of any kind. I further understand that the making of any false or misleading statement or omission from or on this disclosure form, or any other document, will be used to deny me volunteer work, or if currently volunteering, used to terminate my volunteer status. I consider the request for disclosure of pending charges and convictions ongoing and will notify United Way of Racine County of any changes to the statements contained herein. I understand that United Way of Racine County shall not be held liable in any respect if my volunteering is terminated because of false of incomplete statements, answers or omissions made by me on the disclosure form of any other document. In consideration of United Way of Racine County’s review of the document, I hereby release United Way of Racine County, its Board, its agents, as well as all providers of information from any liability and for any damage which may result from the furnishing and receiving of information. A copy of this authorization and release is as valid as the original and should be recognized as such.
This will confirm that the undersigned, having the sole right to do so, for good and valuable consideration (the receipt of which is hereby acknowledged), grants to United Way of Racine County, to include United Way Worldwide and its affiliated organizations, members, successors, assigns and licensees, a non-exclusive and irrevocable right to photograph, record, reproduce, publish, copyright, or otherwise use my name, photographic portraits or pictures, film, videos, internet postings, or sound recordings or any part thereof that may have been taken of me during United Way events and/or activities in written or electronic format, video or film (Content) for promotional, advertising, or other charitable purposes in any media including the world wide web related to the United Way community impact activities. This also includes any tweets or messages through social media. I acknowledge and agree that nothing contained herein requires United Way to use any Content as described herein. I represent and warrant that the consent of no other third party is required to enable United Way to use the Content as described herein, and that such use will not violate or infringe upon the rights of any third parties. I acknowledge and agree that United Way has the right to assign this agreement and/or the rights herein (in whole or in part) to any party. I acknowledge that its sole remedy for any breach shall be an action for damages, and irrevocably waive any right to obtain equitable or injunctive relief. I waive any right of inspection, preapproval, or claims for compensation. I am of full age and have the right to contract in your own name and have read the above consent and permission and are fully aware of its contents. In the event I am a minor, the signature of a parent or legal guardian is required. I will contact United Way of Racine County to make further arrangements. This Consent and Release contains the full and complete understanding between the parties and supersedes all prior agreements and understandings pertaining hereto and cannot be modified except by a writing signed by each party.
After completing the application, click submit once. You will be taken to a confirmation screen. You will also immediately receive an auto-generated confirmation email. If you do not see a confirmation screen, your application has not been submitted. Look for an error message at the top of the page that explains why your application has not been submitted, complete the missing information and click submit again.