Mutual aid organizing form (Click the 3 vertical dots in the upper right next to your account badge, click "make a copy"). If you make a copy for your community, please let me know which community: blaireastcommunitycare@gmail.com

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Section 1 of 2

Times that are potentially scary require us to better support one another. In the same way that we bring casseroles to grieving families and baby clothes to celebrate newborns, we can come together as a community to help each other through this difficult time. An essential part of stopping the spread of coronavirus from overwhelming our hospital systems is voluntary self-isolation (https://www.vox.com/2020/3/10/21171481/coronavirus-us-cases-quarantine-cancellation). However, isolation can be difficult without the support of your neighbors. This form will help us provide support to each other!

Please make a check next to all potential supports that you have the capacity to provide. All offers of support will be kept confidential until a need arises. These are non-binding, but more to get a sense of the abundant resources we do have. At the end, please also tell us about potential situations where you might need assistance, so we can start to match up potential needs with potential offers.

At any time, if you need some support (whether or not you have coronavirus), please email nd2020help@gmail.com and describe the situation and need. We will happily organize support for your home. All requests for support will be kept confidential except to those providing support.

The CDC recognizes community preparedness as an essential part of dealing with this outbreak: https://www.cdc.gov/coronavirus/2019-ncov/community/home/get-your-household-ready-for-COVID-19.html

Thank you!

The person managing this form is Kelly Jiggetts who lives in your neighborhood

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Section 2 of 2

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KName/Pronouns

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Address (optional, but would be helpful)

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Email Address or Cell Phone Number or other electronic contact method

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What time of day are you more generally available? (Please check all that apply)

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Daytime

Evenings

Overnight

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I can provide the following supports: (Remember, this is non-binding. Please check all that apply)

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Meal preparation (daytime)

Meal preparation (nighttime)

Meal preparation (large batches)

Making doctors appointments, calling about medication refills, similar scheduling tasks

Running errands (picking up groceries, medications, etc.)

Signing people up for health insurance

Childcare (daytime)

Childcare (nighttime)

Childcare (overnight/extended)

Childcare (experienced care for a child with high or specialized needs)

Check in on elderly and/or disabled relatives nearby

Pet-sitting/dog-walking, etc.

Household cleaning

Laundry

Dishwashing

Medical response

Spare bed or comfortable couch

Tech support

Translation (Please list language under the "Other" option below)

Translation (ASL)

Transportation

De-escalation, conflict resolution, peace-building skills

Religious/Spiritual ministry (please list faith tradition below in the "Other" box)

I can help donate to a common resource fund

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If you marked any meal prep options above, please list any particular cuisines that you are used to cooking (e.g. Somalian, Italian, Vegan)?

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Are there any other supports that you think we should offer that aren't on the list above?

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Are there any supports that you've offered above for which you normally charge as part of your livelihood? Please list each one and your typical rate (while we want to offer these supports to each other for free, we also recognize the potential burden if this is a part of your livelihood, and we would like to make a plan to compensate you).

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What are some potential needs that you may have that would make it difficult for you to isolate at home in case of coronavirus (e.g. lack of childcare, need for chronic disease medication, your work doesn't offer paid sick leave, you need regular deliveries due to a mobility disability, you have a personal care attendant for a disability who might also have specific needs as well, financial issues from loss of income, etc.)? What are some non-coronavirus related needs that you might have that currently make life difficult?

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Are there other communities that you're connected to that would benefit from organizing some mutual assistance?

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