East Bay Disabled Folks COVID19 Support Request Form
Are you a disabled person (especially prioritizing BIPOC: Black, Indigenous, People of Color) in the East Bay needing extra support re COVID19? Like many people, the Disability Justice Culture Club is working hard to just to meet our own basic needs, but know that disabled and/or elder Black, Brown and people of color are most at risk of being harmed by COVID19. Besides being physiologically most at risk and economically vulnerable (many of us need to work in the gig economy), we are already seeing the early signs of hospital systems being overwhelmed and doctors taking eugenic type approaches to healthcare. We know we are better together. We believe in people power and #NoBodyIsDisposable.

Eres tu una persona con desabilidades (espesialmente prioritizando personas negras, indijenas y personas de color) en el este de la baia nesesitando apollo extra al rededor del COVID19 (virous de corona)? Como muchas personas Disability Justice Culture Club esta trabajando duro para cumplir nuestras nesesidades basicas, pero sabemos que las personas con desabilidades y/o personas mallores, negras, cafes y personas de color estamos con mayor riesgo de ser afectados por COVID19. Ademas de estar fisiologicamente mas en riesgo y economicamente vunerable (muchas de nosotros tenemos que trabajar en lugares que an cerando) lla estamos biendo los signos tempranos que los sistemas de hospitales estan abrumados y los doctores estan tomando enfoques de tipos de eugenesia a la salud. Nosotros creemos en el poder de las personas y #NadieEsDispensable.


If you are a disabled person with needs right now that aren’t being met with your immediate support system, please complete the form below. We may not be able to meet your needs, especially given that grocery stores are very low. Please know that we are especially prioritizing BIPOC (Black, Indigenous, People of Color) who need to limit exposure to others because of health concerns and that we are organizing this as mostly-volunteers organizers who are disabled BIPOC (Black, Indigenous, People of Color) ourselves. We will reach out to you within 48 hours. If you are in Berkeley, please contact Easy Does It Emergency Services at (510) 704-2111. If you're in San Francisco, there is a mutual aid network being led by SDA that is supporting San Franciscans ( https://docs.google.com/forms/d/1hqLnUN22aMoRnKnJJF2CzNP7u-RG5-rhZAz509z9wxE/viewform?edit_requested=true )

Si tu eres una persona con desabilidades con nesesidades en este momento que no estan sido cubiertos con tu sistema de apoyo, porfavor llena la forma de abajo. Ahi posibilidad de que no podamos cumplir tus nesesidades, especialmente tomando en cuenta que las tiendas estan bajas de viveres. Porfavor toma en cuenta que estamos prioratizando minoridades nesesitamos minimisar esponernos a otros porque estamos horganizando todo esto con voluntarios y personas con desabilidades negras morenas y indijenas nosotros mismos. Estaremos contactandote dentro de 48 horas. Si estas en Berkeley, porfavor contacta Easy Does It Emergency Services al (510) 704-2111. Si estas en San Francisco hay alluda mutua que estan dirijidas por SDA que apollan a personas de San Freancisco ( https://docs.google.com/forms/d/1hqLnUN22aMoRnKnJJF2CzNP7u-RG5-rhZAz509z9wxE/viewform?edit_requested=true )

If you are a person with resources to offer, please complete https://tinyurl.com/DJCCally We also very much can use donations via Venmo at @DJCultureClub to help buy protective gear, food, gas money, etc. Any remaining funds will go towards on-going mutual aid organizing and supporting our communities to be more climate-resilient.

Si tu eres una persona con recursos para ofreser, porfabor completa https://tinyurl.com/DJCCally Tambien podemos usar donaciones atrabes de Venmo al @DJCultureClub para alludar comprar equipo protectibo, comida, dinero para gas, ect. Cualquier fondos que no se usen seran usados para segir alludando organizando y apollando a nuestra comunidad a ser resistentes para el cambio climatico.
Email address *
Name / Nombre *
Your answer
Pronouns (ex. he/him, they/them, she/her, etc.) / Pronombres (por ejemplo él, ella...) *
Your answer
Phone Number/ Numero e telefno *
Your answer
Address Including City (Please note: Our efforts are focused on serving the East Bay. We may have some capacity to serve San Francisco and other nearby cities.) Direcion Incluyendo Ciudad (porfavor tome en cuenta que estamos enfocando nuestros esfuerzos en ayudar a las personas de el area de la baia) *
Your answer
Can you tell us about your medical conditions, especially about how they relate to covid19? The reason we are asking is because we may not have capacity to support everyone and may get to the point where we prioritize high risk people. / Nos puedes desir de tus condiciones medicas, espesialmente aserca de como son afectadas por COVIT19? La razon que estamos preguntando es porque hay posivilidad de que no tengamos oportunidad de ayudar a todos y hay posivilidad de que llegue el momento en el que tenemos que prioratizar a las personas con mas riesgo. *
Your answer
What critical needs do you have that aren’t being met right now by your support system? (Examples: grocery shopping, laundry or light housekeeping support while caregiver is sick, med pick-ups, errands, mental health support?)/ Que nesesidades criticas tienes que no estan siendo cubiertas en este momento por tu sistema de apoyo? (por ejemplo: comida, lavar ropa, o limpieza minima de casa mientras tu ayuda normal esta enferma) *
Your answer
What supports are you hoping to receive from us? The more details the better (time, location, restrictions, etc)./ Que apoyo estas esperando recibir de nosotros? Los mas detayes que nos des es mejor ( tiempo, citio, restricciones ect) *
Your answer
How urgent is your need?/ Que tan urgente es tu nesesida? *
If COVID19 continues a few months, how often do you anticipate needing this emergency assistance before you can set up your supports? We are volunteers, many who are disabled ourselves./ Si COVID19 continua por barios meses, que tan seguido anticipas nesesitar esta ayuda de emerjencia anted de que pueda empesar tu apollo propio? Nosotros somos voluntarios y muchos de nosotros tambien somos desabilitados. *
If you are requesting meal support, do you have any restrictions?/ Si estas pidiendo ayuda con comida cuales restriciones tienes? *
Required
Do you need the volunteer supporting you to be fragrance-free? / Nesesitas que el voluntario que te esta alludando este libre de olores/chimicos? *
Can you tell us about your social location (privileges you do or don’t have, whether you are Black, Indigenous, Person of Color, etc) / Nos puedes decir acerca de tu estado social (pribilegio que tienes o no tienes, si eres una persona de color) *
Your answer
Do you need hand sanitizer, masks, or vitamin boosters delivered to you if we have some?/ Nesesitas mascarilla, desinfectante, vitaminas entregada a ti si tenemos? *
Your answer
Would you like a check-in text or call every few days to make sure you are okay?/ Te gustaria que te mandaramos un texto o te llamemos para asegurarnos de tu bienestar? *
Required
Would you like to be added to an ongoing list of community members we hope to check-in within a large scale emergency?/ Te gustaria que te agregaramos a nuestra continua lista de miembros de la comunida que aseguramos de tu bienestar en una emerjencia de escala grande? *
Required
Is there anything you else you would like us to know? (Things you want to offer, questions, comments)/ Hay algo mas que te gustaria que nosotros supieramos?(cosas que te gustaria ofreser, preguntas, comentarios)
Your answer
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