TJA VOAD Application for Membership
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Organization Name: *
I/We hereby expresses my/our commitment to the Virginia VOAD and is in accord with its purposes and plan of organization. As a VOAD member, I/we will seek to coordinate our resources with Member and Partner VOAD organizations in planning for and responding to disasters. Authorized Representative: please put your name below. *
Organization Address: *
Organizations Web Address (put NA if none): *
Primary Contact Name: *
Primary Contact address: *
Primary/Best Contact Number: *
Primary Contact Email: *
Secondary Contact Name:
Secondary Contact Address:
Secondary Contact Number:
Secondary Contact Email:
What geographic area is covered by your organization? *
 Please provide your organizations mission statement (NA if none): *
Please select all areas that reflect the focus of your services and any not listed. Please label your capabilities as one of the following: Primary: (can serve as a lead agency for these services), Secondary: (can provide some capability to do these services) & Tertiary: (could provide untrained volunteers to help with these services) *
Primary
Secondary
Tertiary
NA
Animal Welfare
Building Repair/Rebuild
Case Management*
Chainsaw Crews*
Child Care*
Cleanup Crews*
Cleanup Kits*
Clothing
Communication
Counseling/Licensed
Crisis Intervention
Damage Assessment
Debris Removal Crews*
Donations Management
Emergency Response Teams
Emotional & Spiritual Care
Environment Cleanup/Mold Abatement
Feeding* (Mobile Kitchens*, Food Products Commodities*)
Financial Assistance
Financial Counseling
Generators*
Health Services/Licensed
Health Services/ Non-Licensed
Hospice Care
Information & Referral
In-kind Donations/Bulk
Mental Health Services/Licensed
Mitigation
Mudout
Multi-Lingual Services
Needs Assessment
Portable Showers*
Portable Washer/Dryers*
Prepardness Education
Repair/Rebuild
Shelter Management
Shelters*
Special Populations Services (Please Specify)/Disabled Transportation,Sign Language,Functional Disabilities
Spontaneous Volunteer Management
Support Groups
Tool Trailers*
Transportation/People
Transportation/Goods
Volunteers*
Volunteer Housing
Warehouse Management
Water Purification
Other
Please specify any important details of your service - related costs, number you can provide, etc. *
If your organization does not have a specific mission to assist disaster victims but you want to help, what resources (volunteers, supplies, etc.) could you provide? Indicate below. *
Services Provided (please be as specific as possible in describing the services you can provide. For example, Transportation represents a wide variety of capabilities, “transporting individuals to local appointment or activities” gives a much more accurate picture of the capability). *
Special Capabilities (be as specific as possible in describing special equipment in terms of capabilities they represent. For example “mass feeding trailer capable of supporting 50 persons”). *
Resources are available: *
Please list what counties/cities you can provide services too.
How quickly can you mobilize these resources and personnel? *
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