Applicant details
Name, address, date, date of birth, sex, telephone number and email address.
10-7055
Application for Voluntary Service
- Agency
- VA
- Revision
- February 2016
- Fillable fields
- 25
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-7055: Application for Voluntary Service
VA Form 10-7055 is the Application for Voluntary Service from the U.S. Department of Veterans Affairs, listed on VA's page under the Veterans Health Administration (VHA). The form says it is used to assist personnel of voluntary organizations, which recruit volunteers from their membership, and VA in the selection, screening and placement of volunteers in the nationwide VA Voluntary Service (VAVS) program. It says the volunteer program supplements the medical care and treatment of Veteran patients in all VA facilities.
Page 1 holds the applicant's details, assignment preferences, experience, restrictions, availability, an emergency contact, a monetary waiver with the volunteer's signature, the appointing official's signature and an office use block. Page 2 is for student volunteers, with a student agreement and a parent or guardian consent. The form says completion of this application does not guarantee acceptance into the program.
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What's on VA Form 10-7055
Organization and preferences
Organization memberships if affiliated, three assignment preferences, experience and training (special skills or abilities) and availability by days and times.
Restrictions and emergency contact
Restrictions or limitations of service, such as health concerns, medications or allergies, and an emergency contact with name, relationship and phone number.
Monetary waiver and appointment
The volunteer waives all claims to monetary benefits for services rendered as a volunteer on a without compensation basis and signs. The VAVS Program Manager signs the appointment.
Office use only
Supervisor and supervisor phone number, orientations, uniform, comments and the reviewer's name, title and date.
Page 2: student volunteers
A note to students and parents, the student volunteer agreement with signature and date, and the parent or guardian consent with signature and date.
How to fill out VA Form 10-7055
- 1
Fill in your details
Enter your name, address, contact details, date of birth and any organization memberships at the top of page 1.
- 2
Add preferences and skills
List up to three assignment preferences, your experience and training, and the days and times you are available.
- 3
Note limitations and a contact
Fill in any restrictions or limitations of service and the person to contact in case of emergency.
- 4
Sign the monetary waiver
The form says the waiver applies only to compensation for specific services rendered in the VAVS program and is not related to any other VA services or benefits. Sign and date it as the volunteer.
- 5
Students complete page 2
A student volunteer signs and dates the agreement on page 2, and a parent or guardian signs and dates the consent.
- 6
VA reviews and appoints
The VAVS Program Manager signs the appointment. The form says basic and assignment specific orientations are documented in the official volunteer folder in the VA Voluntary Service Office.
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Appointment, privacy and edition
Appointment
The appointing official's signature appoints the applicant as a VA without-compensation employee subject to the provisions on the application. The form says completion does not guarantee acceptance.
Cancellation
The form notes VA entered into the agreement under 38 U.S.C. 7405(a)(1)(D) and that it may be canceled by either party upon written notice.
Privacy Act
The information is used in the selection and placement of volunteers and kept in system of records 57VA135, Voluntary Service Records-VA. The form says disclosure is voluntary, but not furnishing it will hamper the ability to arrange the most satisfactory assignment.
Edition
OMB Number 2900-0090, estimated average 15 minutes. The footer reads VA FORM FEB 2016 10-7055 and says existing stock of the MAY 2007 edition will be used.
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Who uses VA Form 10-7055?
The form names the people who complete and sign each part.
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Questions about Form 10-7055
What is VA Form 10-7055 used for?
The form says it helps voluntary organizations and VA select, screen and place volunteers in the nationwide VA Voluntary Service program.
Are VA volunteers paid?
The monetary waiver on the form waives all claims to monetary benefits for services rendered as a volunteer worker on a without compensation basis. The form says the waiver is not related to any other VA services or benefits.
Can students volunteer?
Page 2 has a student volunteer agreement and a parent or guardian consent, each with a signature and date line.
Does applying mean I am accepted?
No. The form says completion of this application does not guarantee acceptance into this program.
How long does the form take?
The form estimates an average of 15 minutes, including the time to read instructions, gather the necessary facts and fill out the form.
Who appoints the volunteer?
The VAVS Program Manager signs as the appointing official, appointing the applicant as a VA without-compensation employee.