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.	_______ _______ _______ _______	_______ _______ _______ _______	_______ _______ _______ _______

	Morning	Afternoon	Evening
FRI. SAT. SUN.	_______ _______ _______	_______ _______ _______	_______ _______ _______

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