Resource Survey for Crisis Response
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Church I Represent
*
Church Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Our church has an emergency operations plan.
*
Yes
No
Current Capacity
Our church has some capacity for providing these resources:
Shelter during disaster
*
Yes
No
Workforce Development Services
*
Yes
No
Economic Development Services (e.g. Financial Literacy)
*
Yes
No
Food Distribution
*
Yes
No
Warehousing Space w/Supply Distribution
*
Yes
No
Community Youth Service (e.g. after school, summer programs)
*
Yes
No
Child Care Services
*
Yes
No
Senior Citizen Services
*
Yes
No
Trained Volunteer Teams
*
Yes
No
Our volunteers are trained in:
Other Resources
Additional Comments
Desired Capacity
Our church would like to develop some additional capacity for crisis response.
Yes
No
Capacities our church would like to develop:
Submit
Should be Empty: