ONLINE REGISTRATION FORM

Volunteers for Disaster Response Assistance

     
  If you are an Episcopal chaplain or clergyperson that is interested in volunteering to provide pastoral care, grief counseling, crisis counseling, Critical Incident Stress Management, etc., to the people affected by Hurricane Katrina please fill out this form. We will collect your information and contact you as soon as we have the logistics worked out. At this time we are not coordinating housing for the displaced. Please contact Episcopal Migration Minstries if you would like to volunteer housing for the displaced.
   
  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.
 
  Contact information  
  Full name with proper title:
  Home snail mail address:
  City, State, ZIP for above
  Email address:
  Home phone:
  Cell phone :
  Are you an Episcopalian? Yes    No
  Are you

Lay?   Deacon?   Priest?   Bishop?

  What is your diocese?
 
  Current employment  
  What is your present position? 
  What is the address?
  Work phone
     
  Training Please check if you've had: CPE training   Critical Incident Stress Management training
    Have you received any other kind of disaster response training? No. Yes.
If yes, please describe below:
   
  Experience Describe your disaster response experience:
   
  Availability What dates are you available? 
    Do you have a preference as to where you are willing to go? No   Yes. Please describe below:
   
   
     
  Click here to submit >>       (Print out the "Success" page for your records)