VC-VOAD Membership Application
VC-VOAD is a collaborative of local non-profit agencies, faith-based organizations, volunteer groups, public institutions, and private entities dedicated to improving outcomes for people affected by disasters. VC-VOAD helps communities respond to and recover from major disasters by facilitating cooperation, communication, coordination, and collaboration. 
Email address *
Organization Information
Organization Name *
Your answer
Street Address (Street, City, State, Zip Code)
Your answer
Mailing Address (Street, City, State, Zip Code)
Your answer
Office Phone
Your answer
24-Hour Emergency Phone
Your answer
Fax
Your answer
Website
Your answer
Email
Your answer
Membership Category
Contact Information
State the name and contact information of the main and secondary contacts for VC-VOAD. These individuals must provide complete information for each category and be willing to be reached at any time in the case of emergency.
Primary Contact
Name
Your answer
Street Address (Street, City, State, Zip Code)
Your answer
Emergency Phone
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Fax
Your answer
Email
Your answer
Secondary Contact
Name
Your answer
Street Address (Street, City, State, Zip Code)
Your answer
Emergency Phone
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Fax
Your answer
Email
Your answer
Mission Statement
Please provide the organization's mission statement. Include information on disaster program if applicable. (A separate document with the mission statement may be attached.)
Your answer
Does your organization have a written Emergency Action Plan to protect life and property
Does your organization have a written Disaster Response Plan to respond to community needs?
Available Resources
Please indicate what types of resources and services may be available through organization. (Check as many boxes that apply)
Preparedness/Mitigation
Response/Relief
Recovery
Material Resources
Please list types of items that your organization may be able to offer to the community in times of disaster. Examples: buses, trailers, facilities and other locations that could serve as a collection site or for clothing, ham radios or support coordination of housing assistance and other disaster relief services.
Could your facility be used as a shelter?
If yes, what is the capacity?
Your answer
Access and Functional Needs Provision?
Your answer
List of items your organization may be able to offer to the community in times of disaster
Your answer
Human Services
Please list the number of staff/volunteers your organization would have available to help in times of disaster and their special skills or training. Examples: 5 caseworkers, 4 truck drivers, 6 childcare workers.
Your answer
Spontaneous Volunteers
How would your organization use spontaneous volunteers?
Your answer
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