Community Support and Resources in Response to COVID-19

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This form has been created to support people in need of Community Support and Resources in response to COVID-19. This form is for people looking for help and people able to offer it. Your contact information will only be visible to the Group Moderators

Email Address *

First and Last Name *

Phone Number

I prefer to be contacted by

Phone

Text Message

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I can help neighbors by:

Delivering groceries or other supplies

Picking up prescriptions

Providing transportation

Donating non-perishable food or other supplies

Providing financial support to someone unable to work

Providing child care services

Assembling food packages for donation

Teaching elders how to access delivery from pharmacies and get them signed up

Teaching elders how to get deliveries from grocery stores and sign them up

Teach elders how to do FaceTime

Making calls to seniors and others living alone

Other:

I can do deliveries in the following neighborhoods:

Option 1

Option 2

Option 3

Other:

I am currently in need of help with

Picking up my prescriptions

Transportation

Donations of non-perishable food or other items

Financial support as I am unable to work

Childcare services

Delivery of groceries or other supplies

Other:

If you are currently seeking help, what neighborhood do you live in?

Option 1

Option 2

Option 3

Other:

Please add any additional relevant info here:

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