Data Collection Form

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BLADEN DISASTER
RECOVERY TEAM

Restoring hope to disaster survivors

MISSION STATEMENT

BDRT Data Collection Form

Organization

Representative

Contact Number

Did you or your organization provide services following Hurricane Matthew or Florence? *

Yes

If so, what kind of services did you offer? Please explain in 20 words or less.

Are you willing to provide the same services or other services if a disaster happens? *

Yes

Other

If other service, please explain here in 20 words or less.

Did you encounter any issues or problems that you would like to see fixed in the near future? Please explain in 20 words or less.

Are you aware of the Bladen Disaster Recovery Team? *

Yes

Are you willing to be a volunteer for the Bladen Disaster Recovery Team? *

Yes

Do you know of anyone else who may be a good volunteer, or group that has served in times of disaster in your community? If able, list their contact information.

Thank you for taking the time to answer these questions. Do you mind if you data is used to help create a Disaster Readiness Campaign for Bladen County? *

Yes

Thanks for submitting!

Bladen Disaster Recovery Team will provide disaster recovery preparedness, collaboration, and solutions that is not already being provided in Bladen County for individuals, families, and groups of people impacted by a disaster to assist in the recovery process.

Contact us:

910-874-8034

bdrt19@gmail.com

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