PLEASE REGISTER TO VOLUNTEER Jefferson County Long Term Recovery Group To learn more about our organization, please visit our website: www.jcltrg.org Question Title * 1. Have you participated in disaster volunteer work before? Yes No Question Title * 2. Please provide your full name: Question Title * 3. Please provide your physical address: Number/Street City/State Zip Question Title * 4. Please provide a reliable phone number(s) for us to contact you: Phone number 1: Phone number 2: Question Title * 5. Please provide a working email address that you routinely check. Email 1 Email 2 Question Title * 6. Are you an individual volunteer or are you connected with a organization/church/congregation/other that will be volunteering as a team? Unaffiliated Individual / Independent Volunteer I am with a Group/Team/Organization/Church/Congregation Other (please specify) Question Title * 7. If you represent a group, please let us know the name of the organization/church/congregation/other you represent: Question Title * 8. Please provide us with the physical address of the organization/church/congregation/other you represent: Number/Street City/State Zip Question Title * 9. Please provide us with the website of the organization/church/congregation/other you represent: Question Title * 10. Please provide us with the name of an alternate representative of the organization/church/congregation/other you represent: Question Title * 11. Please provide us with a phone number for the alternate representative of the organization/church/congregation/other you represent: Question Title * 12. Please provide the approximate number of volunteers who will be serving in your group: Question Title * 13. If you are an out-of-town team, please provide the name and address where you and your team will be temporarily housing while you are here: Question Title * 14. If you are already volunteering in our area, please let us know which cities/counties you are currently serving: Question Title * 15. Do you have the tools/equipment necessary to complete the work you would like to do? If you need additional tools/equipment, please provide a brief list of those needs in the box labeled "Other." Yes No Other (please specify) Question Title * 16. If you represent an organization, is this organization a member of a LTRG/COAD/VOAD (local or in another region/state)? Yes No Question Title * 17. If so, please list the name(s) of the LTRG/COAD/VOAD you are a member of: Question Title * 18. What volunteer opportunities most interest you? Assisting an impacted household with home/yard clean up after a disaster Assisting an impacted household with home repairs Providing spiritual and emotional support for storm impacted individuals Working in an emergency shelter or warming station Working a disaster survivor or disaster volunteer registration/assistance event Other (please specify) Question Title * 19. I recognize and support the obligation for myself or the organization I represent to submit situational awareness reports to Jefferson County LTRG and/or county(s) in which myself and/or my team is serving and agree to do so voluntarily and at their request or at the request of county emergency management leadership. 1. Why do we ask for this information? It is important that emergency management and disaster recovery leaders understand what areas of their communities are being served so that they may appropriately direct additional volunteer teams to underserved areas and lessen duplication of efforts.2. We want to make sure every disaster-impacted household reports their damages through the Individual State of Texas Assessment Tool - iSTAT. iSTAT information helps our jurisdictional leaders understand what unmet needs remain in our community and helps our region reach the federal threshold for disaster assistance. Yes No Question Title * 20. Do you agree to collect, log and submit weekly volunteer hours to Jefferson County LTRG and/or county(s) of the area in which you are serving? (We will provide the necessary platform to report these hours) Why do we ask for this information? Collecting and reporting volunteer hours provides valuable data which helps lessen the federal match required of the county in which volunteer groups serve. Yes No Question Title * 21. To benefit our community and expedite a strong long term recovery effort, we need to collect information about the households being served by volunteer groups (ex. address information, work being performed, etc). LTRG's use this information to follow-up on unmet needs, make sure the home damages have been reported in iSTAT (Texas State Disaster Assessment Tool), etc. Do you agree to provide information to us pertaining to the households you or your organization/church/congregation/other is serving? Own Rent Question Title * 22. May we share your contact information with disaster-impacted households that need the volunteer assistance you or your team is providing? Yes No Question Title * 23. Thank you for registering as a volunteer and/or volunteer team with Jefferson County Long Term Recovery Group (JCLTRG). Since 2017 Southeast Texas has been impacted by multiple disasters. With each disaster we learn and better understand the importance of partnerships, collaboration, data collection, information sharing, and protecting the disaster-impacted SETX community - all so we can better serve our disaster impacted households and lessen their suffering as much as possible. For these reasons we collect the information above and disseminate it to the trusted organizations serving our community post disaster. CLICK HERE when your Intake Form is complete
