Benton County COVID-19 Volunteer Availability Form
Please use this form if you would like to make deliveries, give rides, or offer child/ elder/ dependent care.
COVID-19 is a real demonstration of the failure of current systems and authorities to take care of people. We can't rely on them - we protect us. Can you help?
These efforts are the work of the CGE Mutual Aid Caucus and the Benton County Family Response Team. CGE Mutual Aid Caucus is a group of graduate employees at Oregon State University and community allies dedicated to the building of community support networks and helping each other. Benton County Family Response Team is a group of local parents and activists that formed in response to the unprecedented community threat of COVID-19. We are coordinating together and with other local groups in the traditional homelands of the Kalapuya people, the living descendants of whom are members of Confederated Tribes of the Grand Ronde Community of Oregon (
https://www.grandronde.org
) and the Confederated Tribes of Siletz Indians (
http://ctsi.nsn.us
).
* Required
Name
*
Does not have to be your legal name
Your answer
pronouns
*
they/them
she/her
he/him
Other:
Required
Best contact (phone# or email address)
*
If you give a phone number, please specify whether your prefer call or text.
Your answer
Are you currently experiencing symptoms, or do you know if you've been personally exposed to COVID-19?
*
If you have any symptoms or you've been in contact with anyone diagnosed with COVID-19, please self-quarantine and do NOT risk spreading anything to our more vulnerable community members!
Yes
No
What can you offer?
*
Please remember that if you are sick or have been exposed to COVID-19, you should self-quarantine. While we'd love your help, we do NOT want to spread infection, especially to already vulnerable members of our community. Stone Soup provides one full meal each day to anyone who needs it. Breakfast - Sat; lunch - Wed, Fri; dinner - Mon, Tue, Thr, Sun. The Corvallis Daytime Drop-in Center, a daytime community shelter for people experiencing homelessness, is looking for non-vulnerable, temporary volunteers to help out at the organization between 8am-3pm with numerous tasks from food prep and service to cleaning to guest registration upon arrival. Hours can be flexible.
Grocery delivery
Grocery shopping
Food share/ meal prep
Prescription pickup
Child/elder/dependent care
Rides
Remote communication/ social interaction
Laundry (in your home or building)
Pet care/ dog walking
Volunteer shifts at Stone Soup
Volunteer shifts at Daytime Drop-in Center
Tenant support/eviction prevention
Required
Do you need to be paid for your transportation or time?
*
We want to ensure that those who want to provide mutual aid do not face undue burden.
Yes, I cannot do this work without compensation.
Yes, I can donate my time, but I would like to be reimbursed for gas.
No
What is your transportation?
Car
Bike
Public transport/bus
Clear selection
If you checked food share/ meal prep, are there any restrictions or requirements to what you are able to prep?
kosher, vegan, food allergies, etc.
Your answer
Would you like to help pay for the groceries / supplies?
Again, we want to ensure that those who want to provide mutual aid do not face undue burden and we absolutely do not expect you to spend money if you are financially limited.
No, I will need money ahead of time to purchase groceries.
No, I have money to make the initial purchase, but I will need to be reimbursed.
Yes, I have the money to make the initial purchase, and I can donate some, but I may need reimbursement eventually.
Yes, I will donate any groceries I pick up.
Other:
Clear selection
If you checked child/ elder/ dependent care, do you have experience?
Cared for infants
Cared for children
Cared for elders
No experience
Other:
If you checked rides, do you have a wheelchair accessible vehicle?
Yes
No
Clear selection
If you checked communication, are you willing to:
Text
Phone call
Video/ Skype
Lead a video storytime
Lead video yoga or meditation
If you checked laundry, do you need reimbursement for coins/ water/ electricity costs?
Yes
No
Clear selection
If you checked laundry, can you pick up and drop it off, or do you need someone to transport it?
I can transport laundry and wash/dry it
I can only wash/dry laundry; someone else must transport it.
Clear selection
Are you 21+ with valid ID?
*
Yes
No
Where are you located or willing to travel to do this work?
Corvallis
Albany
Philomath
Alsea
further
online only
Do you agree to trust that each person making a request knows their own needs? Can you agree to support people without judgement and a respect for their privacy?
*
(We will not ask anyone to buy or deliver anything illegal.) If your answer is "Yes, except..." please select Other and list the specific supplies or groceries you are uncomfortable buying / delivering.
Yes
No
Other:
What languages do you speak? Can you help us translate, if needed?
*
Your answer
What do you need to feel safe while doing this mutual aid work?
A buddy for rides/deliveries/shopping
Help acquiring hand sanitizer, disinfectant wipes, etc.
Access to face masks
Other:
Do you have any other skills you would like to provide?
We may look into expanding the types of mutual aid we offer, depending on what people ask for and offer.
Your answer
Any other comments or questions?
Your answer
Next
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy