Disaster Volunteer Registration Form    Jefferson, Orange, Hardin, Jasper, Newton Counties (Texas)
www.setxvoad.org

SETXVOAD is a humanitarian association of independent voluntary organizations who may be active in all phases of disaster. Its mission is to foster efficient, streamlined service delivery to people affected by disaster, while eliminating unnecessary duplication of effort, through cooperation in the four phases of disaster: preparation, response, recovery, and mitigation.

To achieve its mission, SETXVOAD collaborates with local, state and federal governmental partners, as well as other nonprofits, including faith-based and community-based organizations, churches, congregations, etc. The jurisdiction of SETXVOAD is Jefferson, Orange, Hardin, Jasper, and Newton Counties. 

We depend on and value volunteers. Please complete the survey below if you are interested in volunteering before/during/after a disaster or weather event. After you complete this survey your information will be sent to the long term recovery group or office representing the county you designate. You will be contacted regarding volunteer opportunities. Thank you!


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Please designate the county in which you/your team prefer to volunteer: 
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1. Please provide your full name: *
2. Please provide your physical address:  *
3. Please provide us with a working email address that is checked regularly: 
4. Please provide us with a working phone number where you can be easily reached (please include area code): *
5. Are you an individual volunteer or are you connected with a  organization/church/congregation/other  that will be volunteering as a team?  *
6. Have you done disaster volunteer work before?  *
7. If you are volunteering with a group, please let us know the name of the organization/church/congregation/other you represent: 
8. Please provide us with the physical address of the organization/church/congregation/other you represent: 
9. Please provide us with the website of the organization/church/congregation/other you represent:
10. Please provide us with the name of an alternate representative of the organization/church/congregation/other you represent:
11. Please provide us with a phone number for the alternate representative of the organization/church/congregation/other you represent:
12. Please provide us with an email address for the alternate representative of the organization/church/congregation/other you represent:
13. Approximate number of volunteers who will be serving with your group: 
14. If you are an out-of-town team, please provide the name and address where you and your team will be temporarily housing while you are here: 
15. If you are already volunteering in our area, please let us know which cities/counties you are currently serving: 
16. Do you have the tools/equipment necessary to complete the work you would like to do?  *
17. If you need additional tools/equipment, please provide a brief list of those needs below: 
18. Is the organization you represent a member of a LTRG/COAD/VOAD (local or in another region/state)?  *
19. If so, please list the name(s) of the LTRG/COAD/VOAD you are a member of:
20. What volunteer opportunities most interest you? *
Required
I recognize and support the obligation for my organization to submit situational awareness reports to SETX VOAD and/or county(s) in which myself and/or my team is serving and agree to do so voluntarily and at the request of the VOAD or county:
 *
Do you agree to collect, log and submit weekly volunteer hours to the SETX VOAD and/or county(s) of the area in which you are serving? (SETX VOAD will provide the necessary platform to report these hours) *
The LTRG's need to collect information from volunteers specific to the households volunteer groups are serving (ex. address information). LTRG's use this information to follow-up on unmet needs, make sure the address damages have been reported in iSTAT (Texas State Disaster Assessment Tool), etc.  Do you agree to provide information to the local LTRG for the households your organization/church/congregation/other is serving? *
May we share your contact information with disaster-impacted households that need the volunteer assistance you or your team is providing?  *
Thank you for completing this survey. Since 2017 Southeast Texas has been impacted by multiple disasters. With each disaster we learn and better understand the importance of partnerships, collaboration, data collection, information sharing, and protecting the disaster-impacted SETX community - all so we can better serve our community. For these reasons we collect the information above and disseminate it to the trusted organizations managing disaster and long term recovery in SETX. 

The officially recognized LTRG's serving SETX: 

Jefferson County Long Term Recovery Group
Michelle Brewer
409-240-0331
director@jcltrg.org

Orange County Disaster Rebuild
Michelle Tubbleville
409-745-9719
mtubbleville@co.orange.tx.us

Hardin County Office of Emergency Management
409-246-5198
(no LTRG)

Jasper/Newton Long Term Recovery Group
Billie Jordan
Billie@jnltrg.com
To learn more about Southeast VOAD or to become involved with our organization, please visit our website: setxvoad.org
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