ENC MWOA - Request for Assistance

To process your request for Men & Women of Action and to assist you in a work project, it is necessary to complete this form giving as much information as possible. Upon completion of this form, your request will be presented to the Men & Women of Action Project Leader for review. You will then be notified as soon as possible concerning your request.

Name of Person Making the Request*

First NameLast Name

Position/Title*

Church's Name*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Office Phone*

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Email*

example@example.com

Languages Spoken*

Location of the project*

Please tell us why you would like Men & Women of Action to assist on your project*

Are you financially able to build/repair this structure without volunteer assistance?*

YesNo

Please Explain*

If not, do you have sufficient finances to purchase all building materials?

YesNo

Is this structure insured?*

YesNo

What portion of this project would you like Men & Women of Action to do? Give Specifics*

What size team can you adequately accommodate?*

Can you accommodate women on this project?*

YesNo

Can you provide free lodging for the team while working?*

YesNo

Please Explain*

If you cannot provide free lodging, where would the team stay? Please give details.

What would be our cost for lodging per day?

Can you provide free meals for the team while working on your project?*

YesUnfortunately NoSome

Please Explain*

If you cannot provide free meals, where would the team have their meals? Please give details.

What would be our cost of meals per day? Breakfast:

What would be our cost of meals per day? Lunch:

What would be our cost of meals per day? Supper:

Please give the name of county and city where this project is located.*

Is electricity available at work site?*

YesNo

If available, what is the voltage?

110 Volt240 VoltGenerator

Please provide any other information, suggestions, or ideas that will be helpful for us to understand your needs more fully.*

Who will be the person responsible for coordination the work project and purchasing all materials, supplies, permits, food, lodging, transportation, etc.?

Name*

First NameLast Name

Position/Title*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Office Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

Languages Spoken*

ENCCOG - Request for Assistance