UMJC's Hurricane Harvey Relief Effort Volunteer Form The UMJC is sending a team to areas affected by Harvey. Please fill out this form if you are interested. If you have any questions, please contact Stephanie Escalante at stephaniee@umjc.org. OK Question Title * 1. Volunteer's Full Name OK Question Title * 2. E-mail Address OK Question Title * 3. Cellphone Number OK Question Title * 4. Which congregation do you attend? OK Question Title * 5. Are you prepared to make your own travel arrangements to assist the effort in Houston? Yes No OK Question Title * 6. When and for how long are you available to volunteer? OK Question Title * 7. Are you able to provide legal services? If so, what kind? Please check all that apply. Brief Legal Advice Limited Scope Service Full Representation N/A In which state(s) are you licensed to practice? OK Question Title * 8. Are you able to provide demolition and repair assistance? If so, what kind? Please check all that apply. Gutting floors and drywall Plumbing Electrical Roofing N/A Please List Other Certifications or Construction Skills: OK Question Title * 9. Are you able to provide Crisis Counseling? If so, what type? Please check all that applies. Crisis Response L.C.S.W. Stress Management Children & Families N/A Please Type License Type(s)/Level or Other Mental Health Assistance: OK Question Title * 10. Do you operate or own any of the following?: Chainsaw Backhoe Generator ATV Own off-road veh/4wd Own truck Own boat Commercial driver Camper/RV Wheelchair transport N/A Please list truck or boat type or Other Operational Skills: OK DONE