Santa Fe COVID-19 Mutual Aid Form
Times seem really wild and unpredictable right now and we can isolate and hoard or possibly find a way to stay in community and help each other out. Safe distancing is important, but so is solidarity.
Here's the idea: pair those in need in Santa Fe with those able to help by filling out this form. We'll do our best to match offers with requests.
This effort was launched by Raashan Ahmad/Beth Gutelius two community members who teamed up with organizers with Earth Care YUCCA/Red Nation/Santa Fe DSA/Fathers NM. The network now includes hundreds of volunteers including a hand-full of dedicated intake callers - who call every person who makes a submission so that we can connect you, our fellow community members, to all the resources we know of as well as the resources of the network.
This is a people-powered initiative by and for ALL people in our community regardless of race, creed, country of origin, immigration status, gender, sexuality, etc. We believe in the practice of solidarity and principles of equity and economic justice and are excited to be sharing and redistributing resources in this time of need.
If you have questions or suggestions contact us at
santafemutualaid@gmail.com
.
FIND THIS FORM IN SPANISH AT/Encuentre el formulario aqui:
https://forms.gle/bZC6U8mHRhQ3irdT6
FIND A DAILY UPDATED LIST OF RESOURCES THAT MAY BE HELPFUL RIGHT NOW REGARDING FOOD, ECONOMIC ASSISTANCE, CHILDCARE, HOMESCHOOLING, ETC AT
www.mutualista.org
*IF YOU ARE IN A RISK CATEGORY, PLEASE KEEP YOUR OWN SAFETY IN MIND IF OFFERING HELP*
* Required
First Name
*
This does not need to be your legal name. You can also add your pronouncs if you want!
Your answer
Last Name
*
You can also add your pronouns if you want!
Your answer
Email
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Do you have texting
*
Yes
No
Are you offering a resource or requesting need?
Resquesting need
Offering a resource
Clear selection
If requesting a need, what are you requesting?
Food/Suppply Pickup and Delivery
Food Assistance (grocery fund, food boxes, etc)
Emotional/spiritual support
Housing
Resources regarding lost wages and financial assitance
Child care
Pet care
Errand
By when do you need this support?
Your answer
If offering a resource, what are you offeing?
Food donation
Grocery/Supply Pickup & Delivery
Housing
Child Care
Errand Running
Emotional/Spiritual Support
Pet Care
Monetary donation
Tutoring/support with distance learning
Other:
What is your availability to offer this support? (do you have scheduling constrainsts? certain days work better than others, frequency, etc)
Your answer
Do you have specific professional skills you can donate to those in need at this time?
Your answer
Further details regarding your need or offer
*
Your answer
Are you in a risk category? (immunocompromised, chroic condition including asthma, hypertension, diabetes, etc)
*
Yes
No
Unsure
Other:
Please share relevant information about your health condition
*
Your answer
Do any of the following apply to you?
*
Please answer honestly. We will not ignore you on the your response to this, we just need to know so we can act accordinly.
I have COVID-19 symptoms (cough, fever, shortness of breath)
I am sick in some other way (cold, flu, anything)
In the last 2 weeks, I have travelled by plane
In the last 2 weeks, I have been in contact with someone who is now quarentine
In the last 2 weeks, I have been in contact with someone who has COVID-19 symptoms
NONE of these apply to me
Required
Help us organize! We need people to help connect offerings to needs
*
Yes, I can help!
I can't help
We're looking for donations to support those in need in our community. Are you in a position to make a donation to support mutual aid work around COVID-19?
*
Yes, I can probably donate
Yes, I may not be able to donate, but can amplify the ask
I am not able to help out in this regard
What languages do you speak?
*
Your answer
Anything else?
Your answer
Which neighborhood do you live in?
*
Airport Rd.
Nort of Airport Rd.
South of Airport Rd.
Around Rodeo Rd.
Siler Rd.
Hickox/Baca
Hopewell/Mann/2nd Street
Salazar/Frenchy's
Santa Fe Community College Area
Santa Fe High School Area
Cordova/Trader Joe's Area
Gonzales/North of Alameda
East Side
Plaza
Highway 14
Las Vegas Highway Area
Santa Fe Trail/South of the Capitol
Tesuque
El Dorado
Madird/Cerrilos/Galisteo/Lamy
Española
Santa Fe County
Other:
Do you want to join a working group
Grocery/Food/Errand Runs
Work Projects - Neighborhood Pantry construction, volunterr at pantries, prepare food boxes, etc
Mask-Making
Neighborhood outreach - flyer distribution, point of contact for your nrighborhood
Resource Development - help us fundraise, enlist people in #sharemycheck campaign and help with backend administration
Other:
Can you #shareyourcheck from federal stimulus bill with members of our community who will not qualify for federal aid due to immigration status, veteran status, etc?
*
Yes
Maybe
No
It is important that we are able to uniquely identify each member of the network - below we ask for your date of birth. This information is not shared with anyone but the intake team and it is used for identification purposes ONLY in order to track fund disbursements.
Date of Birth
MM
/
DD
/
YYYY
Submit
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