NVOAD LTRG/COAD Survey - North Carolina Voluntary Organizations Active in Disaster

NVOAD COAD-LTRG Survey

COAD-LTRG Demographic Survey for NVOAD

Organization Name(Required)

Name of the LTRG or VOAD Agency/Organization/Committee/Coalition

Organization email(Required)

Email address for the organization

Organization phone

Website

Twitter handle

Facebook name

Organization’s Facebook name

Organization State/Territory(Required)

Alabama Counties Served(Required)

Check all counties your organization serves

Alaska Boroughs/Census Areas Served(Required)

Check all areas your organization serves

American Samoa Regions Served(Required)

Check all areas which your organization serves

Eastern District (60010)

Manu’a District (60020)

Rose Island (60030)

Swains Island (60040)

Western District (60050)

Arizona Counties Served(Required)

Check all counties your organization serves.

Arkansas Counties Served(Required)

Check all counties your organization serves.

California Counties Served(Required)

Check all counties your organization serves.

Colorado Counties Served(Required)

Check all counties your organization serves.

Commonwealth of the Northern Mariana Islands Municipalities Served(Required)

Check all municipalities your organization serves.

Northern Islands Municipality (69085)

Rota Municipality (69100)

Saipan Municipality (69110)

Tinian Municipality (69120)

Connecticut Counties Served(Required)

Check all counties your organization serves.

Fairfield (09001)

Hartford (09003)

Litchfield (09005)

Middlesex (09007)

New Haven (09009)

New London (09011)

Tolland (09013)

Windham (09015)

Delaware Counties Served(Required)

Check all counties your organization serves.

Kent (10001)

New Castle (10003)

Sussex (10005)

District of Columbia(Required)

Check this box.

District of Columbia (11001)

Florida Counties Served(Required)

Check all counties your organization serves.

Georgia Counties Served(Required)

Check all counties your organization serves.

Guam(Required)

Check this box.

Guam (66010)

Hawaii Counties Served(Required)

Check all counties your organization serves.

Hawaii (15001)

Honolulu (15003)

Kalawao (15005)

Kauai (15007)

Maui (15009)

Idaho Counties Served(Required)

Check all counties your organization serves.

Illinois Counties Served(Required)

Check all counties your organization serves.

Indiana Counties Served(Required)

Check all counties your organization serves.

Iowa Counties Served(Required)

Check all counties your organization serves.

Kansas Counties Served(Required)

Check all counties your organization serves.

Kentucky Counties Served(Required)

Check all counties your organization serves.

Louisiana Parishes Served(Required)

Check all parishes your organization serves.

Maine Counties Served(Required)

Check all counties your organization serves.

Maryland Counties Served(Required)

Check all counties/city your organization serves.

Massachusetts Counties Served(Required)

Check all counties your organization serves.

Michigan Counties Served(Required)

Check all counties your organization serves.

Minnesota Counties Served(Required)

Check all counties your organization serves.

Mississippi Counties Served(Required)

Check all counties your organization serves.

Missouri Counties Served(Required)

Check all counties/city your organization serves.

Montana Counties Served(Required)

Check all counties your organization serves.

Nebraska Counties Served(Required)

Check all counties your organization serves.

Nevada Counties Served(Required)

Check all counties/city your organization serves.

New Hampshire Counties Served(Required)

Check all counties your organization serves.

New Jersey Counties Served(Required)

Check all counties your organization serves.

New Mexico Counties Served(Required)

Check all counties your organization serves.

New York Counties/Boroughs Served(Required)

Check all counties/boroughs your organization serves.

North Carolina Counties Served(Required)

Check all counties your organization serves.

North Dakota Counties Served(Required)

Check all counties your organization serves.

Ohio Counties Served(Required)

Check all counties your organization serves.

Oklahoma Counties Served(Required)

Check all counties your organization serves.

Oregon Counties Served(Required)

Check all counties your organization serves.

Pennsylvania Counties Served(Required)

Check all counties your organization serves.

Puerto Rico Municipios Atendidos(Required)

Marque todos los municipios a los que sirve su organización.

Rhode Island Counties Served(Required)

Check all counties your organization serves.

Bristol (44001)

Kent (44003)

Newport (44005)

Providence (44007)

Washington (44009)

South Carolina Counties Served(Required)

Check all counties your organization serves.

South Dakota Counties Served(Required)

Check all counties your organization serves.

Tennessee Counties Served(Required)

Check all counties your organization serves.

Texas Counties Served(Required)

Check all counties your organization serves.

U.S. Virgin Islands(Required)

Check the islands your organization serves.

St. Croix (78010)

St. John (78020)

St. Thomas (78030)

Utah Counties Served(Required)

Check all counties your organization serves.

Vermont Counties Served(Required)

Check all counties your organization serves.

Virginia Counties and Cities Served(Required)

Check all counties and cities your organization serves.

Washington Counties Served(Required)

Check all counties your organization serves.

West Virginia Counties Served(Required)

Check all counties your organization serves.

Wisconsin Counties Served(Required)

Check all counties your organization serves.

Wyoming Counties Served(Required)

Check all counties your organization serves.

Disaster Types Served(Required)

Check all types of disaster your agency has served

Disasters served

List all the disaster-years your agency has served. Example: Hurricane Fran-1996. Hurricane Floyd-1999, Tornadoes-2011, TS Julia-2016, Fire-2018, Flood-2021

Year established

Year your organization was formed

Status(Required)

Operational status of your organization

Fiscal Agent

Enter the name of the organization’s fiscal agent if any. (A fiscal agent is an organization that acts on behalf of another party performing various financial duties. A fiscal agent could be a parent organization or other organization that handles finances and files IRS paperwork.)

Primary Contact Name(Required)

First Last

Primary Contact Job Title(Required)

Position within the organization

Primary contact email(Required)

Primary contact phone

Primary Contact Fax

Alternate Contact 1 Name

First Last

Alternate Contact 1 Email

Alternate Contact 1 Phone

Alternate Contact 2 Name

First Last

Alternate Contact 2 Email

Alternate Contact 2 Phone

Structure

Indicate your organization identity and services it offers. Select each item that applies to your organization

Area specific disaster collaborative (often Voluntary Organization Active in Disaster or Community Organization Active in Disaster)

Disaster-caused unmet needs (often Long-Term Recovery Group)

Long-Term Recovery Group is officially attached to Community Organization Active in Disaster/Voluntary Organization Active in Disaster

Organization is a member of the state/territory VOAD

Organization has an IRS 501(c)(3) Letter of Determination

Organization has bylaws

Organization has an established board

Services

Indicate your organization identity and services it offers. Select each item that applies to your organization

Organization provides Disaster Case Management

Organization provides Construction Management

Organization provides Volunteer Management

Organization provides Emotional and Spiritual Care

Organization provides Financial Counseling

Organization provides Advocacy

Other Services Offered

Please list

Comments

This is a pilot. Please let us know of any difficulties or ambiguities you encountered.

Comments

This field is for validation purposes and should be left unchanged.