Volunteer Intake Form

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Thank you for your willingness to volunteer with the MS Rapid Response Coalition. The Mississippi Rapid Response Coalition (MRRC) is a coalition of over thirty organizations and individuals coming together to mobilize Mississippi communities to provide rapid response support in times of crisis, whether the crisis is caused by disaster natural or infrastructure failures. The Coalition is led by the People's Advocacy Institute, Mississippi Poor People's Campaign, One Voice MS, Southern Poverty Law Center, Immigrant Alliance for Justice and Equity (IAJE), Alternate ROOTS, Mississippi Moves, Operation Good, Strong Arms of Mississippi, Mississippi Black Women's Round Table and over thirty partner organizations.

We are currently seeking volunteers to assist with relief efforts for communities in the MS Delta that were impacted by the recent Tornado and severe storms.

Please complete this entire form, you will be contacted within 48 hours. If you have any questions, please email us at rapidresponse@peoplesadvocacyinstitute.com.

First Name *

Last Name *

Phone Number *

Email Address *

City, State, Zip Code *

What types of volunteer work are you interested in? (Please choose all that apply) *

Response Hotline ( You do not need to live in MS, can be done remotely. It requires a lot of volunteers and is open from 8am to 8pm)

Intake (We are assessing and responding to needs of people in the impacted area.)

Returning calls and voicemails (We will be returning calls from 8am to 7pm.)

Delivering supplies to communities or homes (11am - 7pm)

Finance Coordinator (9am - 7pm: Calling hotels and stores for supplies and vacancies)

Clean-up of Impacted Area

Debris and Tree Removal

Other:

Required

What date are you available to start volunteering? *

YYYY

Below is a list of areas impacted by the recent tornadoes and sever storms. Please indicate which location you would like to volunteer.

Belzoni/Silver City/Humphries County

Winona

Rolling Fork

Amory

Straight Bayou/Sharkey County

Black Hawk/ Carol County/Vaden/Summerfield

Anguilla

Other:

Clear selection

When are you available to volunteer (starting the day you listed above)? All times are in Central Standard Time Zone *

Not available

8am - 9am

9am - 10am

10am - 11am

11am - 12pm

12pm - 1pm

1pm - 2pm

2pm - 3pm

3pm - 4pm

4pm - 5pm

5pm - 6pm

6pm - 7pm

7pm - 8pm

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

If you selected HOTLINE are you able to take overflow calls during peak hours outside of your shift time? (Tell us when you are flexible in "OTHER")

Yes

Maybe

Other:

Clear selection

Are you a student and need community service hours signed off? *

No I am not a student

Yes - JSU

Yes - TC

Other:

Clear form

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