Home Repair Intake

Flood Recovery Volunteer Application Form

"*" indicates required fields

Type of Application*

Team Leader

Team Member

Independent Volunteer

Are You Local or Non-Local?*

Local (from Breathitt, Knott, Leslie, or Perry County, KY)

State (Kentucky)

Out-of-State

Name*

First Last

Preferred Name

Address*

Street Address or P.O. Box Address Line 2 City State ZIP Code

Phone*

Email*

Birthdate

Name of Organization

Organization Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Name

First Last

Emergency Contact Phone

When Are You Available to Serve?*

Group Size*

"Small Skilled" means that your group has Advanced Skills in construction.

Small (4-8 Members)

Small Skilled (5-10 Members)

Large (10+/MAX of 55)

Groups of more than 5 are often split up into separate crews (ex. a crew of 10 will be split into 2 crews of 5) and sent to different work sites. Are you okay with this?*

Yes

Not Sure

Skill Level*

Do you have any construction experience?

No Experience

Basic Skills

Advanced Skills

Skills

What skillsets or abilities do you have that you would like to use while serving with HDA?

How many people are you bringing?*

Please include age ranges and how many of each (teens, 20-25, Over 25, and Seniors/age 62 & Up).

Are you bringing additional people who will not be working at the sites? If so, what will be their role(s) during your stay?*

Are there any special needs (ex. food allergies, health/mobility issues, or medical conditions) that you'd like us to be aware of? Please describe.*

Ways to Engage*

Please indicate the desired ways in which you wish to serve. If there is something you prefer not to do, make sure not to select it in this list.

Home Muck Outs (Includes crawl spaces) & Mold Remediation

New Home Construction

Home Repairs

Skilled Contractor

Wherever I Am Needed

Have you ever served with us before?*

Yes

If so, when?

How did you hear about our organization?*

Social Media

HDA Website

TV or Newspaper/Magazine

Word of Mouth

Other

We require all groups to provide their own vehicles for transportation to and from the work sites each day. Each work site vehicle should be able to accommodate a group of at least four volunteers. Vans work very well for work site transportation. School buses are not allowed. NOTE: You MUST have a vehicle for each work crew. Crews are a maximum of SIX people. If you have more than 6 volunteers in your group, you must bring at least 2 vehicles to transport them to work sites.

How many work site vehicles will you bring with you?*

Do you need contact information for local van rental agencies?*

Yes

Are You Serving Multiple Days & Need Accommodations?

Yes

Yes - I'm signing up for the weeklong experience!

Do you intend to use our accommodations?*

Yes

If not, please tell us where you'll be staying:

All groups MUST specify their arrival date and departure date. If you are using HDA-provided accommodations, you may choose to stay late/arrive early for Sunday services at First Presbyterian Church, First Baptist Church, or Mother of Good Counsel Catholic Church in Hazard, though this is not required.

Arrival Date*

Departure Date*

Are you interested in participating in Sunday services at the church providing your lodging? (Participation is optional.) Note: If you'd like to attend a different church in our area, please let us know and we'll send you a list of churches and Sunday service times.*

Yes

What kinds of cultural, educational, and/or other recreational activities are you interested in, if any?

Whenever possible, we try to plan and schedule activities for you to participate in during your weeklong stay.

Inclement Weather Notice

We hope you have a bright, sunny week, but you know what they say: "You can't predict the weather!" This is especially true in the state of Kentucky, where the weather is often varied and unpredictable within the same day/week. You may experience an all-day downpour, or it could be a brief shower that you can wait out. If we make the decision to stop work, please know that it's in the interest of your safety! Thank you for understanding that construction & carpentry work very much depend on the weather.

Signature*

By typing my name into this field, I am confirming that the above information is accurate.

Signature Date*

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Comments

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

Please fill out this contact form and let us know what kind of help you need. A member of our staff will contact you ASAP.

Flood Survivor Assistance Request

Assistance Request
Are you a survivor of the July 2022 East Kentucky flood? If your home was damaged and you are in need of repairs, please contact us. If you lost your home to the flood and/or are hoping to rebuild, please get in touch. We may be able to help you!
Name*
First Last
Email
Mailing Address*
Street Address/P.O. Box Address Line 2 City State ZIP / Postal Code
Phone*
Alternate Phone Number (if needed)
What are you in need of?*
Which county in our service area do you currently live in, or which county are you most interested in living?*
Please note that HDA only serves these counties in East Kentucky. You must already live in one of these counties or be willing to live in one of them.
- Breathitt County
- Floyd County
- Knott County
- Leslie County
- Perry County
Message*
Briefly let us know how we can help you.
What is the best way to contact you?*
- Email
- Phone
- Text
- Postal Mail
If text is selected as the best way to contact you, please provide your carrier.
How did you hear about us?*
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Comments
This field is for validation purposes and should be left unchanged.

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Flood Recovery Volunteer Application Form

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