Dear Neighbors,                                                                  March __, 2020

[Our names are ____ / My name is ____].  As you’ve been hearing on the news, we are in the middle of a national response to an outbreak of the coronavirus.  As a result, the state of California has taken many safety measures, including banning large gatherings, closing schools, and encouraging those who are older or who have lower immune systems to stay home.

Although we are not experts, we are your neighbors and we believe this is a moment where we must look out for each other and help each other out.

In the days ahead, there may be things that you need and things you are able to provide.  We’d like to get organized now.  If you would like, please fill out this form and either drop it back off at my house or mail it to me at [your name, your address].  You can also call or text [your name] if that is easier: [your phone number]




Telephone: __________________        E-mail: ______________________________

Best way to get in touch: ___Call            ____ Text             ____ E-mail          ____ In-Person

I’m able to help with the following:

____ I could go to the pharmacy or grocery store for a neighbor and deliver supplies

____ I could help out a neighbor financially with paying for groceries or other supplies (if you’re able to do this, can you estimate for us what you could contribute? $____)

____ Something else (please write in):

I might need help with the following:

____ I might need somebody to run errands for me like the grocery store or pharmacy

____ I might need financial support for groceries or other supplies

____ Something else (please write in):