Deerfield Valley Support Need Form
The Deerfield Valley is a community of caring people. Many people are volunteering ways to help and others are in need of help. This form has been created to collect information about folks who need assistance and support.

If you are interested in volunteering to help, there is another form you can use at: https://forms.gle/UWm3yxWb2xSG4djb7

After you submit this form someone from an appropriate organization will contact you as soon as possible.

Our top priority is making sure that all community members have what they need to enable them to stay home, whether sick or healthy. Thank you for taking care of each other right now.

Please note that we do not take responsibility for vetting or guaranteeing any services engaged through this form. We provide only the contacts and it is the volunteer and recipient's sole responsibility to choose to participate with other parties.

If you are experiencing an immediate medical or other emergency, please call 9-1-1.

Call 2-1-1 (or visit https://vermont211.org/) for additional help locating a wide variety of services and support in Vermont.

UPDATE & PLEASE NOTE: There is a new resource for essential workers who need help finding childcare. In addition to giving us your information in this survey, go to: https://webportalapp.com/webform/essentialworkers OR call 2-1-1 ext. 6.

Additionally, the Deerfield Valley Food Pantry is assist eligible people or households with access to food. Leave them a message at (802) 464-0148 to check on the current distribution schedule, and note that they are currently offering a 'drive-up' service only for the safety of their volunteers.

FYI FOR THOSE IN RECOVERY FROM DRUG/ALCOHOL MISUSE DISORDER:
The Vermont Recovery Network has established an inbound number to provide peer to peer support for recovery from alcoholism/substance misuse disorder: 802.808.8877 9a - 9p There is also a variety of resources at https://vthelplink.org/
Name (first and last) *
Your answer
Phone Number (put c for cell please) *
Your answer
Email
Your answer
Town of Residence *
Your answer
Best way to contact you: *
I am filling out this form for a friend or neighbor I am worried about and would like someone to check in on them. (if yes, go on to the next question)
Contact I'd like you to reach out to if Yes above:
Your answer
Possible needs
Please answer "Yes" to any of the needs you might currently have. If your need is not listed, please indicate what you are looking for in the final question.
Do you need supplies delivered? Please note that you will be responsible for coordinating with your volunteer to arrange for prepayment, or to reimburse them for supplies. If you are experiencing financial hardship, indicate this in the following question and we will attempt to connect you to an appropriate organization.
Are you experiencing financial difficulties would prevent you from being able to reimburse a volunteer for supplies?
Are you over 60 and in need of hot or prepared meals?
Are you in need of check-ins from neighbors via phone or online platform to help with isolation?
Are you experiencing food insecurity?
Any other needs you have, please list them here and we will do our best to get them met.
Your answer
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