Kenai Peninsula Borough
Community Emergency Response Team (CERT)

CERT Program Volunteer Survey

 
Please help us make the most of your volunteer time and interest!

 
Name:  
Mailing Address:  
Physical Address:  
Home Phone:       Work Phone:     Cell Phone:
Email Address:  

Best way to contact you:  Home Phone   Work Phone   Cell Phone   Email

 
Estimated number of hours you can commit each year:  
How do you prefer to arrange these hours?
daily    weekly    monthly    quarterly    one time per year   
other (specify): 

 
Please list any skills, knowledge, hobbies or areas of interest you have and would be willing to
share with other CERT volunteers (ex:  GPS orienteering, SAR, wilderness medicine, ham radio, equipment operations, etc):

 
Are you willing to (please check all that apply):
attend CERT meetings     weekly    monthly    quarterly
complete FEMA IS100 and IS700 online classes
provide input or help set up volunteer meetings, activities and supplemental training and exercises
help with program outreach (speakers bureau, newsletter or newspaper articles, etc.)
help with September National Preparedness Month activities and outreach
help staff a booth at safety fairs and other events
work with your neighbors on emergency preparedness (Map Your Neighborhood)
assist your local fire department with home and fire safety projects
other (please specify): 

 
Additional comments or questions:
Thank you for your participation!