City of Flint Request Form for Free Masks

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Mayor Sheldon Neeley and the City of Flint are helping to distribute masks to places of worship throughout Genese County as well as small businesses in the City of Flint as part of a partnership with the Charles Stewart Mott Foundation and the Food Bank of Eastern Michigan. Complete this form to make a request for masks for your organization.

Masks also are available for residents and families through the community Help Centers.

Email *

Name *

Title

Phone number *

Number of masks being requested *

100

200

Other:

Name of the organization for which masks are being requested: *

Address of the organization for which masks are being requested? Please include street address, city, state, ZIP *

Is this in the City of Flint? *

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of City of Flint. Report Abuse

Forms