Humboldt COVID-19 Response: Community Needs Intake Form
Currently our capacity to meet needs is very limited. We can help with running errands for those that sheltering in place, but are unfortunately not able to provide any type of financial assistance at this time.
If you are looking for resources for food sources, you can access one of our Little Free Pantries (
), which are usually stocked with food and other goods depending upon location.
We do not provide cash assistance. Please do not ask us to send you money.
Name or Pseudonym
What is the best way to contact you? (Phone number or email: Please put both if available)
General location? (Please choose the area you're closest to)
Address or specific location we can reach you
Type of Assistance Needed (Note: We do not provide financial aid)
Sanitation or medical supplies (please specify below)
Someone to talk to / help dealing with isolation
I need help within the next 48 hours
I need help within the next week
I need help within the next month
Any specifics in notes? (Grocery items, details, food allergies, etc.)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service