Greater Nashua VOAD Membership Form
In times of disaster, every organization has something they can contribute to the community; be it tangible goods, services, manpower, or time, everyone can help. Keeping precise and accurate account of resources ensures that VOAD members effectively and efficiently serve their community. This form facilitates collaboration by helping agencies understand one another's role and capabilities, thus reducing duplication of services and ensuring that those affected are aided quickly.
Sign in to Google to save your progress. Learn more
VOAD Logo
Organization Name *
Street Address *
Town *
State *
Zip Code *
Organization Phone Number *
Organization Email *
Website
Organization Type: *
Required
Geographic Area Served: *
Required
Does your organization have paid staff? *
How many volunteers are with your organization? *
How many staff members are with your organization? *
Point(s) of Contact
Please put the contact information of individuals that handle disaster response and that can be reached during emergencies.
Name of Primary Contact in Case of Emergency *
Position *
Mobile Phone Number *
Work Phone Number
Home Phone Number
Email *
What is the best way to contact this person outside of work hours? *
Has this person attended a VOAD meeting previously? *
Name of Secondary Contact in Case of Emergency *
Position *
Mobile Phone Number *
Work Phone Number
Home Phone Number
Email *
What is the best way to contact this person outside of work hours? *
Has this person attended a VOAD meeting previously? *
Tertiary Contact in Case of Emergency
Position *
Mobile Phone Number *
Work Phone Number
Home Phone Number
Email *
What is the best way to contact this person outside of work hours? *
Has this person attended a VOAD meeting previously? *
Please describe the services/goods/assistance your organization offers, or could contribute to the community in the planning/mitigation, response, and recovery phases of an emergency. *
Is your organization willing and/or able to provide services outside of normal business hours? *
Is your organization listed in NH 211? *
Is your organization willing to contribute to disaster relief efforts in areas outside your local base? *
Would your organization be willing and able to utilize spontaneous volunteers during an emergency? *
If your organization is willing and able to utilize spontaneous volunteers during an emergency, are there any requirements or training they must complete before starting? What types of roles would you use them in?
Is your organization willing to share your Membership Resources information with other organizations/the public when providing disaster assistance? *
(ie. Church groups, NH VOAD, etc)
Please mark/describe any applicable areas in which your organization could provide assistance. *
Please select the areas for which your members have been trained in.
Non-Disaster
During Disaster
Non-Disaster and During Disaster
N/A
Disaster Education
Clothing
Mass Care
Client Advocacy
Legal Counseling
Real Estate
Temporary/ Permanent Housing
Skilled Labor
Building Supplies
Transportation
Waste Management
Debris Management
Warehouse/ Storage
Goods Distribution
Spiritual Care
Financial Counseling
Casework
HAM radio
IT/Computers
Media Relations
Community Outreach
Event Planning
Clean Up Assessment
Exterior Debris Removal
Interior Debris/Contents Removal
Muck Out
Gutting
Final Cleaning & Sanitizing
Communications
Technology Support
Community Assessment of Unmet Needs
Disaster Casework
Disaster Case Management
Care for Caregiver
Crisis Counseling
Disaster Mental Health Care
Disaster Spiritual Care Providers
Psychological First Aid
Donations Management
Emergency Assistance
Child Care
Relocation Services
Medical Care
Dental Care
Medication Replacement
Long Term Recovery Group
Shelter Management
Feeding
Food Services
Family Reunification Services
Shower Units
Laundry Units
Outreach and Information Services
Pet Care/Sheltering
Preparedness/Mitigation
Build Repair/Rebuild
Construction Management
Construction Estimation
Volunteer Reception Center Management
Affiliated Volunteers
Unaffiliated Volunteer Management
Volunteer Housing
Other Response or Recovery Activities:
Additional comments that may help us understand your organizations of services:
Does your organization have a facility that could be used for a response and recovery purpose? (ex. shelter, warming center, charging center, etc.) *
If yes, additional questions will be provided on Page 2 about your first facility.
Does your organization have a second facility that could be used for a response and recovery purpose? (ex. shelter, warming center, charging center, etc.) *
If yes, additional questions will be provided on Page 3 about your second facility.
Does your organization have a third facility that could be used for a response and recovery purpose? (ex. shelter, warming center, charging center, etc.) *
If yes, additional questions will be provided on Page 4 about your third facility.
Does your organization have a fourth facility that could be used for a response and recovery purpose? (ex. shelter, warming center, charging center, etc.) *
If yes, additional questions will be provided on Page 5 about your fourth facility.
Does your organization have a fifth facility that could be used for a response and recovery purpose? (ex. shelter, warming center, charging center, etc.) *
If yes, additional questions will be provided on Page 6 about your fifth facility.
Does your organization rely on other non-profits or corporations to accomplish your mission? *
If yes, who do you rely on?
What other organizations does your organization typically partner with during disaster relief at the State and National Level? *
Does your organization have an Emergency Action Plan (EAP) or Emergency Operations Plan (EOP)? *
Does your organization have a Continuity of Operations Plan (COOP) or Business Continuity Plan (BCP)? *
If "No" or "In Progress" to either, would you like someone from Nashua Office of Emergency Management to contact you for assistance in developing a plan?
Clear selection
Would you be interested in hosting a Greater Nashua VOAD Meeting? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms