Jackson Water Crisis - Volunteer Intake Form

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Please complete this entire form, you will be contacted shortly to discuss training and needs. We appreciate any amount of time people can offer (Even if it's just 1hr.)

First Name *

Last Name *

Phone Number *

Email Address *

City, State, Zip Code *

What types of volunteer work are you ready to do? (Please choose all that apply) *

Water Distribution (10am - 8pm: Jackson MS/Hinds County: You will be at one of the many Water Distribution sites across the city helping load water into cars and intaking any water donations. This requires a lot of volunteers)

Water Delivery/Pickup (11am - 5pm: Central MS/Hinds County: A truck/car is prefered but not required, we can provide gas stipends.)

Crisis Response Hotline (10am - 5pm: You do not need to live in MS, can be done remotely.)

Wellness Checks (10am - 5pm: We are attempting to text and check on over 10k Mississippians and gauge what supplies and resources we can move to those communities. May be needed to return calls as well.)

Returning calls and voicemails (10am - 5pm: We will be returning calls or inputting them into an online intake system to be dispatched to the appropriate response team)

Finance Coordinator (9am - 7pm: Calling stores for supplies and coordinating their delivery or pickup)

Required

If you selected Water Distribution or Water Delivery/Pickups. What parts of the city would you prefer to volunteer? (Check all that apply.)

South Jackson

West Jackson

North Jackson

I can pick up donations outside of Jackson.

What date are you available to start volunteering? *

YYYY

When are you available to volunteer (starting the day you listed above)? All times are in Central Standard Time Zone *

Not available

8am - 9am

9am - 10am

10am - 11am

11am - 12pm

12pm - 1pm

1pm - 2pm

2pm - 3pm

3pm - 4pm

4pm - 5pm

5pm - 6pm

6pm - 7pm

7pm - 8pm

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you a JSU🐯 or TC🦅 student and need community service hours signed off? *

No I am not a student

Yes - JSU🐯

Yes - TC🦅

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