Disaster Response Team

Team Leader Information:
*First Name
*Last Name
*Phone
*Email
Alternate Phone Number
Team Information:
*Team Name
*Organization Name
*Organization Address, City, State
Organization Phone Number
Organization Email
*Type of Team
Rebuilding
ERT
VIM
NOMAD
Other
Other Type
Number of Adults on Team

Specify the number of adults on team (age 18 and older)

Number of Youth on Team

Specify the number of youth on team (ages 14 to 17)

Languages Spoken by Team Members
*Housing Required?
Yes
No
*Available Dates of Team

Please indicate date ranges of availability

Previous Experience
Additional Information
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