Tornado Disaster Relief: Data Collection Form
The purpose of this form is to identify: remaining potential types of crisis; community partners/collaborators who are or desire to deliver recovery/relief services and the role they desire to play in the coordinated efforts; resources available to aid in disaster recovery/relief; and assess long term community needs for at- risk areas and special populations impacted by the disaster. This data will allow disaster relief efforts from grassroots initiatives to publicly funded projects to be coordinated - providing comprehensive community solutions to the victims of the 2019 Memorial Day Tornadoes.
City, State, and Zip
Agency Telephone Number:
Executive Director Name:
Executive Director Email Address:
Primary Disaster Relief Contact Name:
Primary Disaster Relief Email Address:
Type of Entity:
Non profit - Community Organization
Faith Based Organization
Grassroots Initiative -no special tax status
For Profit Business
Type of service currently being offered to ANY victim of the disaster.
In this response please include ONLY services available to any victim. If your services are specific to a certain geographic area please describe this in the Services Description Question. Responses to this question will allow long the long term response team to identify unmet needs and community assets available to all victims.
Emergency Material Household Goods - Bedding, pans, dishes, cleaning supplies, towels, washcloths, hotpads, cutting boards, silverware, etc.
Financial Assistance for Personal Documents Recovery
Financial Assistance for Transportation
Financial Assistance for Rent and Deposit
Financial Assistance with Utilities
Financial Assistance non category specific
Debris Clean Up - Free
Debris Clean up - For a fee
Rebuilding physical home structures
Free Rebuilding Supplies
Volunteer Sign up and coordination
Relief Fund Donation Collection
Material Good Donation Collection
Food Donation Collection
Other Donation Collection
Long or short term Case management
Baby/New mother needs
Safe sleep boxes, baby cribs or pack and plays
Behavior Health/Grief support
Current Recovery/Relief Services Description
Please describe the services being delivered. Include days and times of operation, expected length of time the organization will provide the service. Please report the number of people you have the capacity to serve.
Target Population and Eligibility Requirements
Please describe the population of people your recovery/relief efforts serves. Please include geographic location, demographic descriptions, and any specific eligibility requirements.
Please list all current collaborative partners specific to your recovery/relief services. If you are not collaborating with any other entity or are self funding your services please write n/a. Please include any funding sources of recovery/relief services as well as collaborating service providers, front doors, or community systems in your response.
Please use this space to explain any other information you would like us or the target population to know about your services.
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