Volunteer Survey

INDIVIDUAL VOLUNTEER SURVEY

Name:__________________________________ Church: ____________________________
Day phone # __________________ Night # ________________ Email: __________________
Complete Address: ___________________________________________________________
Times Available: _____________________________________________________________
{days of the week; or specific dates; or for how long (e.g., one week in January)}
Type of vehicle/#number of passengers, if willing to drive to site __________________________
Health Insurance Co/Policy # ____________________________________________________
Medical problems that might limit your activities ______________________________________
Emergency contact: _______________________ Phone #'s: ___________________________
Primary physician's name and number: _____________________________________________

SUMMARY OF SKILLS

Foreman (F) - able to lay out amterials and work, oversee others
Journeyman (J) - skilled and equipped
Handyman (H) - some experience and equipment
Unskilled (U) - no skill

Circle the appropriate level of each skill. Also note at bottom if you are NC licensed in a trade.
Specify details and particulars in final column where appropriate.

Please list any other gifts of personality, training, or experience that you think might be useful to a
mission team (patience, ability to speak Spanish; physically strong, etc.)

If you want to be entered into the Presbytery of WNC data bank of potential disaster team
participants, please return this form to: PWNC Disaster Response Network, 114 Silver Creek Rd
Morganton, NC 28655