Technical Assistance Registration
 

Type of Assistance:

     Volunteer
     Salary Only
     Expenses Only
     Salary and Expenses
     

 

Describe education (degrees) and language capabilities:

 

Do you have disaster response experience [if yes, please explain]:

     yes
     no
First Name
Last Name
Address
Address
City
State
Zip
Birth Year
Phone (1)
Phone (2)
E-Mail
Occupation
Employer
Start Date
Duration
Service/Skills:

 

Do you currently hold a valid passport:

             yes           no

 

This information can be given to governmental and non-governmental organizations:

             yes           no

   

 

 Notes:  entry is required where field is bold

First Name  
Last Name  
Address  
Address   space for second line of address information
City  
State  
Zip  
Birth Year   year of birth
Phone (1)   primary phone
Phone (2)   secondary phone
E-Mail   e-mail address
Occupation   
Employer  
Start Date   date you are available to start service
Duration   length of time available


Type of Assistance:

Is this offer for voluntary service, or do you expect to be paid.  If so, are you expecting to be paid a fee or salary for service, expenses, or both.

 

Disaster Experience:

If you have previous disaster assistance experience, please give sufficient details for follow-up.

 

Service/Skills:

Give a good account of your background and how you expect to contribute in a disaster response.

 

Valid Passport:

In order to be considered for overseas assistance, it is necessary to have a valid passport.  You may not have the appropriate visa(s), but those are more readily obtained.

 

Release Information:

The information you have provided is accessed by agencies (governmental and non-governmental) working in the disaster location.  If you choose to not make your information available to agencies, you will not be considered for providing response assistance through the CIDI and your information will not be included in the database.