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 More About You
