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Disaster Response Database
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Add Response
Instructions  (pdf)
FAQ's  (pdf)
Project/Grant Number:   (required)
CNCS Program Type:   (required)
Project/Sponsor/Legal applicant name:   (required)
Event Name:   (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): 		  Select(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):		   Select(required)
Stories of service (optional):  
City of disaster related assignment:   (required)
State of disaster related assignment:   (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.
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