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.
Agency Name: *
Your answer
Street Address: *
Your answer
City, State, and Zip *
Your answer
Agency Telephone Number: *
Your answer
Executive Director Name: *
Your answer
Executive Director Email Address: *
Your answer
Primary Disaster Relief Contact Name: *
Your answer
Primary Disaster Relief Email Address: *
Your answer
Type of Entity: *
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.
Required
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.
Your answer
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.
Your answer
Collaborative Partners *
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.
Your answer
Miscellaneous: *
Please use this space to explain any other information you would like us or the target population to know about your services.
Your answer
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