Resilience Hub Interest Form

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Interested in developing or participating in a Community Resilience Hub? Fill out this form with information on your organization, facilities, and needs, and we’ll help you get started.

Prior to completing this form, please review the information about Resilience Hubs at https://cecsb.org/resilience-hubs.

Name *

Email *

Phone

Business/Organization name (if applicable) *

Please include other important contacts that need to be included in communications regarding Resilience Hub development.

Facility Address *

Do you own or lease? *

Own

Lease/Rent

Other:

Provide a brief description of the facility you operate. *

Facility total area (gross square feet) *

Number of buildings that comprise the facility

Estimate the number of residents that utilize the facility and services (regular operations).
*

Total Occupancy of Facility

Describe the accessibility of the facility (please cover the following):

- Proximity to public transit service

- ADA ramps, doorways, bathrooms/grab bars, chairs, communication tools (deaf/blind)

- Capacity, experience, and/or training, etc.) in serving Access & Functional Needs (AFN) populations, such as elderly, children, people with disabilities, etc.

- Languages spoken by frontline staff

If applicable, describe the facility’s food service(s), storage and/or preparation facilities and operations.

If applicable, Describe the current emergency operations, functions and community services offered at your facility (e.g. point of distribution, emergency shelter, medical shelter). Describe other organizations or agencies that are involved with emergency activation and operation.

Check the type of services/activities that may be provided at your facility.
*

Emergency Shelter

Evacuation Center or Temporary Evacuation Point

Warming and/or Cooling Center

Resource Relief Sites (like Public Safety Power Shutoff Community Resource Centers)

Community Points of Distribution

Mutual Aid-style Programming

Other:

Required

Check the type of services/activities that you need support with. *

Forming partnerships with government agencies and other organizations that serve the community during emergencies

Connecting to Climate Resilience Education and Programing

Connecting to your County's Energy Assurance Services (Free Energy Efficiency Planning)

A personalized specialist to help navigate electrification and green tech incentives and rebates

Completion of a full Facility Energy Audit

Technical support to create a Resilience Hub Site Design Plan

Technical support to create a community engagement and outreach plan

Grant writing assistance

Other:

Required

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I would like to participate and contribute to testimonial media

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