Shopping Assistance Order Request
Harlan County CAA shopping assisters will take orders for food and/or personal items, pick up items, and deliver to clients’ houses.
We will take orders for Harlan County residents who are unable to shop for themselves or protect themselves during this time of physical distancing, including single care parents at time of need who is unable to go to a grocery store with children. For more information, please go to
After you fill out this order request, we will contact you to go over details, availability, and alternative options before the order is completed. If you have any questions or concerns, please contact us at 606-573-5335 or send us an email to
Sign in to Google
to save your progress.
Are you a Harlan County resident?
Never submit passwords through Google Forms.
This form was created inside of Harlan County CAA.