Last Name   *

First Name  *

Middle Name

DOB     *

Age GroupPlease select14-1819-2425-64Over 64 *

Have you ever volunteered for the Cross? Please selectYesNo *  If YES, please list chapter affilliations

Have you ever held any Red Cross  cerfitications? Please selectYesNo *  If YES, Please list certifications held.

A "Yes" answer to the following italicized questions does not auromatically disqualify an applicant.

Have you been convicted of a felony or a misdemeanor in the last 24 months?  Please selectYesNo *  If YES, please explain

Have you ever had any of your Red Cross certifications revoked?  Please selectYesNo *   If YES, please explain

Areas of Interest Chapter Needs When a disaster strikes preliminary disaster assessments should be completed within 24 hours. This assessment will tell us the size and scope of the disaster. If necessary, shelters will need to be opened. Then according to the size ‘of the disaster, activation of other disaster response functions will need to be determined. these activities could include client casework, financial and statistical information, mobile feeding and/or bulk distribution (see descriptions below). We need to have volunteers trained in these functions and available to meet the response demands if our . chapter jurisdiction is affected by a disaster. Leaders are needed where there is a desire to be trained in the corresponding area and where there is a focus on the Red Cross Mission. Please compete this questionnaire so that we can match your volunteer interests and your skills with our volunteer opportunities. 1. Are you available for:(Please check areas of interest.)   National - Requires 2 week commitment Local Statwide - 0 Day commitment Local - Chapter jurisdiction only Any of the above 2. Which Group/Activity are you interested in? The groups/activities listed below fall into the initial response phase and are the positions we will need to fill immediately.  (Please   check areas of interest.)  a  Sheltering - Provides for the sheltering needs of those affected by disaster. We are in need of Shelter Managers as well as Shelter Workers. The shelter manager provides the supervision and administrative responsibilities within the shelter. Shelter workers work the registration desk, kitchen, dormitory, and logistics.  b  Mass Care - Provides fixed and mobile feeding services for disaster victims and  emergency worker~ iri the affected area and distribution of supplies and commodities to people  affected by the disaster.  c    Disaster Assessment - Determines the size/scope and impact ofthe disaster and the level of damage sustained by dwellings within the affected area.  d    Client Services - Responsible for providing individual assistance at service delivery sites. Interview clients, assess their need, and assist with immediate emergency needs.  e    Financial and Statistical Information Management - Controls and processes all client assistance. Maintains master files and compiles statistics related to the relief operation  f  Partner Services (Government Liaison) - Working within established policies and procedures, this assignment serves as the primary communication channel between the Red Cross disaster relief operation and the local emergency operations center or incident command post. There are other volunteer opportunities available please see list below. Please place a check mark in the box next to the item(s) that most interest you. Current Volunteer Opportunities  Disaster Action Team - These are volunteers who are willing to handle local disaster cases;they are subject to rotating on-calls for weekends and eveningsand mainly handle our single family disasters. 9/9/2010  Help with One-time events - Volunteers are often needed to help with a one time event in their community - disaster fair, fundraiser or a training event. Most one-time assignments involve groups of volunteers, a club, school, or church group:  Short-term assignments - Volunteers are often needed to tackle a specific project completed in a designated time frame. Times could vary from a few days to more than a months. Possibilities could include updating a booklet or manual, updating computer database, etc.  Disaster Clerical - Volunteers needed to assemble class packets, stamp brochures, and distribute disaster safety information in the community.  Speakers - Volunteers needed to do presentations within the community.  Clerical - Volunteers needed to assist with bulk mailing, filing and inventory.  Maintenance - Volunteers needed to help with routine maintenance duties (stocking supplies, doing inventory) at the chapter.  Community Disaster Education - Opportunities to help the community, businesses or schools prepare and respond to disasters.  Disaster Response Planning- Assist with workshops, drills, tabletop exercises.    Special projects -Volunteers needed to work directly with Exec. Director on fundraising events.