Diocesan Contact's Form for a Congregation Wanting to Help a Congregation Impacted by Hurricanes Katrina and Rita

     
Thank you for indicating your willingness to consider partnering with one of the congregations impacted by Hurricanes Katrina or Rita. This form should be completed by Diocesan Coordinators. However, if you are interested in providing immediate/short-term assistance or human services please contact Episcopal Relief and Development or the Diocese of Mississippi. Those congregations wishing to help in relocations and aid to evacuees should contact Episcopal Migration Ministries. Congregations wishing to help should go to the "What Your Diocese is Doing " page and click to find you diocese and the contact info for your diocesan contact.
   
  CAUTION: Please use the "Tab" key to move between fields. Hitting the "Return" or "Enter" key will result in the form being submitted before completion.
 
  1. Name of congregation and diocese:
  2a. Street address:
  2b. City, State, ZIP for above
  3. Church contact information  
   
Office phone
Office FAX
Office email
Church web site address (if any)
  4. Name of Rector:
  5. Name of Key Contact Person for matters regarding the partnership
  Key Contact's
Primary phone
Secondary phone
Best time to call
FAX
Email address
  6. Church membership Average Sunday attendance:
     
  7. Readiness status of congregation to partner with one of the storm impacted congregations (Please check only one of the following):
 
  (a) Our rector, vestry, other church leadership, et al. have discussed the partnership idea and we are ready to move forward with concrete assistance now. Also our bishop has been informed of our desire to be a partnering congregation and he/she is supportive of our doing so.
  (b) We are in the discussion stage with rector, vestry, etc. and will likely be ready soon .
  (c) Some key persons are excited about the possibility of participating but we are not yet in consensus
  (d) Other (Please amplify)

  8. If you checked 7 (a) or (b) above please complete the following:
 
  (a) We are offering financial assistance in the approximate amount of that we can either give directly to the congregation or to the diocese to use for support of that congregation.
  (b) We are willing to send a team of workers to assist in any way needed. The workers we can offer are qualified to do manual labor to assist with building construction/repair; mental wellness counseling; other
(specify).
 
     
  Click here to submit >>       (Print out the "Success" page for your records)