Contribution Form for Neighbors Affected by COVID-19: Garfield Park

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This form is for neighbors of the Garfield Park community to offer skills, resources, supplies, space, and time to community members who are affected by COVID-19 and our most vulnerable residents.

Please fill out this form and we will do our best to match you with someone who could benefit from your contribution.

*This form is managed by the Garfield Park Community Council and was created on March 30, 2020 and updated on April 9th*

Your Name *

Mobile Phone Number *

Where are you located? (To locally match you with someone in need) *

East Garfield Park

West Garfield Park

Around the Conservatory

Around Madison and Pulaski

Other:

Required

What kind of donation can you offer?

Groceries

Household supplies (soap, hand sanitizer, toothpaste, paper towels, toilet paper, deoderant)

Buy an Instacart gift card for a family who can't leave their house

Children's educational materials (books, workbooks, textbooks, old laptop/tablet/computer)

Children's educational materials for children ages 4 to 7

Children's educational materials for children ages 7 to 10

Children's educational materials for children ages 10+

Transit Pass/Ride

1 on 1 check-ins (phone call, Zoom, etc to touch base with a neighbor)

Other:

Are you able to deliver your donations to a household in the Garfield Park area?

Yes

Other:

Clear selection

Can you deliver food from a pantry to a household in need in Garfield Park ?

Yes

Other:

Clear selection

Can you place an online order for a household in need in Garfield Park?

Yes

Other:

Clear selection

Questions/Comments/Suggestions?

Submit

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