REQUEST FORM - North Valley Mutual Aid - COVID19
Hello

The idea behind this is to crowd source some mutual aid for folks in the Butte County/North Valley area.

If you are in need, please fill out the following survey. The information you provide will be posted publicly (within our community) to a google doc that will be shared so folks can contact you if they are able to help. We do not ask for your name to maintain privacy before accepting the aid.

If you'd like to help, please see this survey results google doc link below and mark you name in column Q if you are going to contact to help that person: https://docs.google.com/spreadsheets/d/1T5kx7dVOYwDJ6wRhcGopbaA6hAiSTMrGr0G747brrYQ/edit?usp=sharing

DISCLOSURE: The host of this document cannot guarantee that all requests for aid will be met but is simply a community member offering to share a document and allow others to help each other. Please be responsible when arranging things with folks you have not met. The host accepts no liability around these arrangements.

Please email nvma@riseup.net to have any information removed or changed.

Questions, updates or want to get involved?
     Facebook: https://www.facebook.com/northvalleymutualaid
     Email: nvma@riseup.net 
     Join the google group for announcements: mutual-aid-community-response@googlegroups.com
     Volunteer: https://forms.gle/iEM7rGAori9ZSBeW7

A Chronic Illness Patient's Guide to Coronavirus:
https://awareness.creakyjoints.org/coronavirus/?link_id=3&can_id=490ba7e62bd1d59cd488c422899b7f99&source=email-when-every-community-is-ground-zero&email_referrer=email_749340&email_subject=when-every-community-is-ground-zero
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I am seeking assistance with... *
Required
Describe a little more what you need help with. *
Where do you live? *
Please list the neighborhood or town you live in.
How would you like to be contacted? *
Please list the best phone number or email for those that would like to help to contact you.
What pronouns do you use?
For example, they/them, she/her, he/him, ze/zir, and more.
What language(s) do you speak? *
Do you identify as undocumented, queer, trans*, Black, Indigenous, and/or a person of color?
Are you over the age of 60? *
Do you have a chronic health condition that affects your immune system? *
Have you had a fever or flu like symptoms in the last week? *
Have you been tested for Coronavirus? *
Are there specific things you want a person to know who is helping you?
Are you able to reimburse the person buying supplies?
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DISCLOSURE: This information will be shared on a PUBLIC google doc which is why we ask that you do not leave your name or address. Those who are willing and able to help will be able to access the google doc and will contact you via the information you provide below.
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