Name:Last *First *
Address: *
City: *      State: *     Zip: *
Phone: *
Email: *Area *

Please indicate your areas of knowledge with experience

Area of Experience	Experience
Emergency Operations Center *	Yes No
Administration*	Yes No
Communications*	Yes No
Logistics Management *	Yes No

                                                                  

Please indicate the software programs you are proficient with. (Mark all applicable areas)

E-Team
Excel
Word
Access
PowerPoint
Other:

Please indicate the areas that you can assist with. (Mark all applicable areas)

Data Entry (E-Team)
Damage Assessment (Requires Field Work)
Donations Management
Local Emergency Operations Center Support
State Emergency Operations Center (SEOC) Call Center
Administrative Support
Disaster Recovery Centers
GIS Support
Logistics/Resource Management
Other:

If notified, how long would you be able to support disaster operations *

1-5 days
2 weeks
1 month
Other (explain)

If notified, when could you report for disaster duty?*

Within 24 hours
Within 48 hours
Within 1 week
Other (explain)

Participation in the SEMA Reservist Program is completely voluntary. Submission of information does not constitute a call-up during times of emergency. This information is being collected for determination of program feasibility during declared and undeclared emergencies affecting the State of Missouri