City of Little Rock Disaster Recovery Grant: Volunteer Application

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* 1. Full Name

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* 2. Home Zip Code

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* 3. Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

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* 4. What is your gender?

Female

Male

Other (specify)

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* 5. What is your age?

18-24

25-34

35-44

45-54

55-64

65+

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* 6. Preferred Email Address

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* 7. Preferred Phone Number

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* 8. Please share any conflicts of interest that may arise in this process. Conflicts may include being directly impacted by the March 31 tornado, or having a close family member impacted.

I certify that I have no financial or personal interest, direct or indirect, in any matter that raises or may raise a conflict with my duties as a volunteer with the City of Little Rock Disaster Recovery Grant.

I have a financial or other personal interest, direct or indirect, in certain matters that raises or may raise a conflict with my duties as a volunteer with the City of Little Rock Disaster Recovery Grant.

City of Little Rock Disaster Recovery Grant: Volunteer Application

Question Title

* 1. Full Name

Question Title

* 2. Home Zip Code

Question Title

* 3. Which race/ethnicity best describes you? (Please choose only one.)

Question Title

* 4. What is your gender?

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* 5. What is your age?

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* 6. Preferred Email Address

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* 7. Preferred Phone Number

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* 8. Please share any conflicts of interest that may arise in this process. Conflicts may include being directly impacted by the March 31 tornado, or having a close family member impacted.

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* 9. Please describe the details of the matter that raises or may raise a conflict.