National Disaster Volunteer & Donation Form

Mr.Mrs.Ms.CorporationNon Profit

Birth Date:

I am willing to volunteer in:
This countryA neighboring countyAnywhere in the stateAnywhere in the US

Are you currently affiliated with a disaster relief agency? If yes, name of agency:

Special skills and/or vocational/disaster training:

I am willing to:
VolunteerMake financialIn-kind contributions

Do you have your own equipment to appropriately share? If so, please explain

SKILLS: Please check all that apply.

Medical
Doctor Specialty:Nurse Specialty:Emerg. Medical cert.Mental health counsel.VeterinarianVet. technicianOther

Communications
CB or ham operatorHotline operatorOwn a cell phoneOwn a skyphonePublic relationsWeb page designPublic speakerOther

Languages
FrenchGermanItalianSpanishUkrainianOther

Office Support
Clerical (filing, etc.)Data entry-SoftwarePhone receptionistOther

Services
FoodElderly/disabled asst.Child careSpiritual counselingSocial workSearch and rescueAuto repair/towingTraffic controlCrime watchAnimal rescueAnimal careRunnerDisability Service:Other

Structural
Damage assessmentMetal constructionWood constructionBlock construction CertPlumbing CertElectrical CertRoofing CertOther

Transportation
CarWagon/mini-vanMaxi-vanATVOff-road veh./4WDTruckBoatCommercial driverCamper/RVWheelchair transportOther

Labor
Loading/shippingSorting/packingClean-upOperate equipment TypesSupervising othersOther

Equipment
BackhoeChainsawGeneratorOther

Volunteering Information

Please check the appropriate boxes below - any and all responses are helpful and appreciated!

What interests you most about volunteering?

Gain confidenceMake a differenceInteracting with other volunteersBe part of a communityAcquiring new skills and experienceTake on a challengeOther

Which projects are most appealing to you?

Stewardship/MonitoringOffice/ClericalVTS DirectorRegistrationInterviewerData/Agency CoordinatorSafety TrainerVolunteer ID StaffMapperPhone Bank StaffData EntryRunnerPublic Information OfficerSecurityOther

What physical activity level(s) are you comfortable with?

Negligible - Office/clerical, newsletter, website, etcLight - Public/group interaction, some walkingMedium - Regular walking/monitoringHeavy - Property management/maintenanceAnything - Bring it on!

Do you have any prior volunteer experience?

YesNo

Do you have experience using computers?

YesNo

How often would you be interested in volunteering?

WeeklyOne-timeAnnuallyMonthlyOther

What times/days fit best into your schedule?

MorningsAfternoonsEveningsWeekendsWeekdaysSpecific Day(s)

Would you consider donating to Volunteer To Serve a 501(c)(3) tax-exempt charity to help us achieve our mission?

We are currently seeking:
ID badgesTablesChairsPoster BoardsClipboardsPaperPensFlashlightsFiles for maintaining FormsComputersTentsWaterVehicles (Cars/Trucks)Permanent markersDry erase markers and eraserSharpie markersColored chalkStaplersPush pinsMasking tapeClear (shipping) tapeStick-on name badgesScissorsStringWalkie-TalkiesCellphones

Volunteering Information

More About You