Disaster Response Database
Add Response
Instructions
(pdf)
FAQ's
(pdf)
Project/Grant Number:
(required)
CNCS Program Type:
** Please Select **
AmeriCorps State/National
VISTA
NCCC
RSVP
FGP
SCP
Learn and Serve America
SVP
next Generation Grant
Challenge Grant
other
(required)
Project/Sponsor/Legal applicant name:
(required)
Event Name:
** Please Select **
Katrina
Rita
Wilma
other
(required)
Other (Please specify):
Total number of national service participants responding
in these activities to date:
(required)
Number of national service participants responding
in these activities currently:
(required)
Total estimated number of hours served
by national service participants
responding in these activities:
(required)
Service Category:
(Select all that apply)
Community clean-up
donations/warehouse management
sheltering/feeding
housing repair/renovation
tutoring
collecting/shipping donations
youth activities
interim/temporary housing support
fundraising
Disaster Recovery Center support
volunteer management
Other(give detail)
long-term recovery
Description of Activities:
(required)
Major Partners:
(Select all that apply)
FEMA
Habitat for Humanity
Red Cross
VOAD
Salvation Army
Army Corps of Engineers
United Way
Christian Contractors
State Commission
Southern Baptists
Volunteer Center
Other(give detail)
Start date of activities
(these are only the activities that you are
reporting and describing here
not the dates of your entire program activities):
(required)
End date of activities
(these are only the activities that you are
reporting and describing here
not the dates of your entire program activities):
(required)
Stories of service (optional):
City of disaster related assignment:
(required)
State of disaster related assignment:
** Please Select **
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
(required)
Zip Code of disaster related assignment (optional):
Original assignment city/state (if different):
Total number of community volunteers recruited:
Total number of hours served by community volunteers
(if available):
Total Dollar Amount
of Monetary Grants, Cash Donations, and Fundraising Generated
(optional):
Total Dollar Amount
of In-kind Donated Goods and Services Generated
(optional):
Reported By:
(Contact Information)
First Name:
(required)
Last Name:
(required)
Address:
(required)
Phone number (area code, number, extension):
(required)
Email address:
(required)
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Disaster Relief Information Collection
OMB NO.: 3045-0114
EXPIRATION DATE: 04/30/2006
Last updated: November 10, 2005
Copyright © 2005 Corporation for National and Community Service.