Online Enrollment Form
Online Enrollment Form

If you have already joined Compassion Coalition of Tuscaloosa County, Inc. but you need to review or update your information, please do not fill out this form again. You can use this form to access your information instead.

Please enter the following information about your faith-based organization.
All fields must be completed. If you do not have information
for one of the fields, please enter the word none instead.

Faith-based organization name:   
Name of the ministerial leader:    Title (Pastor, Rev., Dr., Rabbi, Imam, etc.):
Mailing Address
Address:
City: , AL    Postal zip code:
Physical Address (if different than mailing address)
Address:
City: , AL    Postal zip code:
Organization's email address:
Organization's phone number: (205)    Fax: (205)    Cell: (205)
Note: If you do not have a fax or cell number, please enter the word "none" - do not leave it blank.


Please list more than one representative from your organization in case the primary representative is unavailable or cannot be reached.
Name of your representative to Compassion Coalition:
Title (Mr., Ms., Mrs., Miss, Other):    Home phone:    Email:
Work phone:    Cell:    Fax:    Pager:
Note: If you do not have a work, cell, fax, or pager number, please enter the word "none" - do not leave it blank.
Name of your first alternative to Compassion Coalition:
Title (Mr., Ms., Mrs., Miss, Other):    Home phone:    Email:
Work phone:    Cell:    Fax:    Pager:
Note: If you do not have a work, cell, fax, or pager number, please enter the word "none" - do not leave it blank.
Name of your second alternative to Compassion Coalition:
Title (Mr., Ms., Mrs., Miss, Other):    Home phone:    Email:
Work phone:    Cell:    Fax:    Pager:
Note: If you do not have a work, cell, fax, or pager number, please enter the word "none" - do not leave it blank.


There are 12 emergency response categories below. Please check at least one service from one or more of the 12 emergency response categories your faith-based organization could contribute before or during a disaster. We strongly encourage all members to contribute at least three services if at all possible.

A. Food
1. Food storage facilities
2. Bottled water pantry donations
3. Food pantry donations
4. Paper product donations
5. Kitchen supplies/equipment donations
6. Food vouchers/gift cards
7. Food preparation
8. Congregational dining facility
9. Meal distribution
10. Other:
 
B. Clothing
1. Clothing storage facilities
2. Clothing donations
3. Clothing vouchers/gift cards
4. Clothing distribution
 
C. Shelter
1. Shelter or "safe haven" site
2. Temporary housing or apartment site
3. Temporary housing vouchers (first & last month deposits, etc.)
 
D. Services By Age/Ability/Language
1. Child care/children’s services
2. Elderly services
3. Special needs (disabled)
4. Sign Language
5. Foreign language:
 
E. Furniture & Appliances
1. Furniture/appliance warehousing
2. Furniture/appliance donations
3. Furniture/appliance vouchers/gift cards
4. Furniture/appliance distribution
 
F. Financial
1. Support (other than vouchers/gift cards previously listed):
2. Utility bill assistance
3. Telephone calling card assistance
4. School supplies assistance
5. Other:
 
G. Building/Repairs
1. Building material warehousing
2. Building material donations
3. Skilled volunteer labor:
4. Unskilled volunteer labor
5. Chain saw team
6. Mud out team
7. Other specialized tools/equipment or team:
 
H. Training & Coordination
1. Coordination of volunteer groups
2. Other:
 
I. Transportation
1. Transportation to/from appointments
2. Gas vouchers/gift cards
3. Other transportation:
 
J. Miscellaneous
1. Portable shower construction/set-up
2. Water purification construction/set-up
3. Volunteer-at-large/volunteer as needed
4. Ham Operator
5. Other:
 
K. Counseling
1. Critical incident stress management (CISM) volunteer or team
2. Certified grief counselor or team
 
L. Compassion Coalition Organization
1. Interest/expertise in disaster response:
2. Interest in joining advisory council to facilitate coalition
3. Interest as administrative volunteer
4. Interest as computer volunteer
5. Interest as website volunteer