Roseville Volunteer Force Request for Help Form
This form should be used by seniors, people with medical conditions, single moms, or similar, that struggle with getting supplies or necessary errands that they need. If you are able-bodied and just can't find the supplies/services you are looking for, please post those requests in the Roseville Volunteer Force Facebook (
) group to see if the group volunteers can assist you with those needs.
NOTE: The information you provide below will only be shared with our leadership and the volunteer(s) that help you obtain these items or services. It will not be used for any other purpose.
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First & Last Name
Are you a Senior?
Do you have special medical condition that requires you to stay home?
What is it that you need?
Household Supplies / Cleaning
What specific items do you need that you can't find?
Can you safely pick up goods from someone's porch or do you need it delivered to your porch?
I can pick it up
I need it delivered
Street Address and Apt # if Applicable
Gate Code or Other Instructions? Otherwise Enter N/A
Area of Town / Nearest Cross Roads/Intersection / Landmark
Mobile Phone (N/A if not applicable)
If Mobile phone, can we text you?
If you don't know how to text or don't have texting capability, please select No.
If reimbursement is necessary, what form can you use?
If assigned a shopper, DO NOT offer a credit card to the shopper!
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