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Print this form, and return to your church contact person for LOVE INC.

MINISTRY OUTREACH INVENTORY

LOVE INC can help members of local churches become involved in responding to individual and family needs, which arise, or currently exist. Our church is participation in this program because we believe it will give each church member a precious opportunity to put his/her Christian faith and love to work in the service of those in need.
LOVE INC will refer neighbors with legitimate needs to the trained Contact Person from our church. This Contact Person will give you the opportunity to provide the service you indicated on this survey.
Name__________________________________________________________
Address________________________________________________________
Phone__________________
Age________________
NOTE: If you are unable to help when called upon, you may simply decline that request.

Available Hours: (please check)
Morning Afternoon Evening
MON.
TUE.
WED.
THURS.
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Morning Afternoon Evening
FRI.
SAT.
SUN.
_______
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I AM WILLING TO VOLUNTEER IN THE FOLLOWING AREAS:
(Please Check)

__Assist with shopping once or twice a week
__Assist with filling out various forms
__Shop for elderly, disabled or shut-in
once or twice a month
__Transporting people to medical appointments
once/twice a month
__Deliver food occasionally with adequate notice
__House Cleaning
__Home Maintenance
__Nutritional Counseling (advice on grocery shopping)
__Visit shut-ins, elderly, disabled or handicapped
once __twice __more often__
__Respite Care for single parents or those living
with handicapped persons
__Companionship for elderly
__helping somebody move in your truck
__Do yard work for disable and elder
__Share Skills: _Auto _appliance _other
__Translation help: Language_______
__Counselor (family)
__Establish friendships with new family
__Legal Assistance
__Medical Assistance (Physician)
__Dental Assistance
__Medical Management Counseling
__Share Parenting Skills
__Budget Planning Counseling
__Plumbing
__Carpentry
__Electrical Work
__Housing for Unwed Mothers
__Assist Family in reducing energy costs
__Provide Short-term emergency housing
__Meal Planning
__Tutor Adults
__Tutor Children
__Donate Baby Supplies or Furniture
__Temporary Baby-sitting or child care
__Financial Aid (for utility bills/medicine)
__Make a follow-up call or visit a family
helped through LOVE INC
__Counselor (Professional)
__Other Talents, skills, and interest or helps:
______________________________________

P.S. I may be willing to serve one or more shifts as a phone volunteer in the LOVE INC Clearinghouse. (Shifts are 9 a.m. - Noon or Noon - 3 p.m. Mon.-Fri. Training is provided.) Please Contact me with details. _________

PLEASE PRINT AND RETURN TO YOUR CHURCH CONTACT PERSON FOR LOVE INC