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Organization
Name
Phone (required for verification purposes)
Type Religious Organization (Church, Synogogue, Mosque)
State/Local Govt. (City Office, State-run Program)
Civic/Community Organization (Local United Way/Salvation Army/Red Cross chapter, Community Action organization)
Business
Other
Description
Address
City
State Zip Code
Website

Point of Contact at Organization
Contact Name
Position at Organization
Phone (if different from public phone of organization)
Email


Evacuee Placement
Do you currently have evacuees in your area in need of housing? Yes No

Are you willing to help evacuees find housing? Yes No
   If yes, we can get you a secure login to our database of empty housing offered to Hurricane survivors.

Would you help the placement process by checking the ID's of evacuees? Yes No

Are you willing/capable of performing background checks for evacuees? Yes No
If Yes, Description of background checking abilities


Can you help arrange transportation for evacuees? Yes No Maybe
If Yes, Description of transportation abilities


Housing/Services
Do you have VACANT/EMPTY, NOT Shared, housing available to Katrina survivors?
Yes No
If Yes, Description of housing offer


Do you have a large number of housing offers available in a digital format? Yes No
  If YES, we will contact you about getting that information to case workers.
If NO, please list offers available below.


Multiple Housing Details
  City/State Housing Type # of Units # of Beds/Unit Furnished Length Avail. Other Details
1.
  Rent: $/Month
2.
  Rent: $/Month
3.
  Rent: $/Month
4.
  Rent: $/Month
5.
  Rent: $/Month
6.
  Rent: $/Month
7.
  Rent: $/Month
Extended Services

Do you have job placement services?
Yes No
If Yes, Description of job program

Can you help connect survivors to furnishings, supplies and other local services?
Yes No
If Yes, Description of Offer

Can you offer medical/psychological services?
Yes No
If Yes, Description of extended services


Other Comments By Organization


Do you agree to the Terms of Use of this site? We will share this information with valid relief organizations who are actively working to place families.
Yes No