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Worcester Covid-19 Mutual Aid Help Request Form
Please use this form to submit a request for delivery or help for yourself or someone who may not have access to google forms.

If you’re symptomatic, please call the Health Dept. Covid-19 hotline: (802) 863-7240

Are you feeling ill? Find yourself stuck at home, needing something from the outside world? We're here to help!

Volunteers in and around Worcester are coming together to support you with the goods/groceries you need!

Fill out the form below - we'll be in touch quickly.

For resources available to Vermonter's call 211or check out the collaborative Covid-19 resource document:
https://docs.google.com/document/d/17DJMyLZR_Fk7MzaCD9AU0O8a61VGVvoeNs4qbVk0z3E/edit?usp=sharing

For any questions about this form, volunteering, or a delivery request, please email
The Worcester Neighborhood Network (worcester-neighbor-network@googlegroups.com), kristin.henningsen@gmail.com, or call the Worcester Town Clerk at (802) 223-6942 for questions or to become an organizer!
Name *
Your answer
Address for Delivery *
Your answer
Additional details about accessing your home (e.g.; steep driveway, mud!, or shared driveway).
Your answer
Phone (if none, put n/a)
Your answer
Email address *
Your answer
What are your needs - food, water, medicine, etc.?
Your answer
Form of Payment for groceries or other items (check, cash, Venmo, PayPal, etc...):
Your answer
If you are feeling isolated and in need of connection, are you interested free peer-to-peer counseling via phone or online platform?
Is there anything else you would like your courier to know?
Your answer
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