Sitka Mutual Aid - Support Request
We are coordinating food and supply drop offs to support each other in the face of the Covid-19 pandemic. Please use this form if you would like something delivered and/or if you need financial assistance for groceries. We will share the details of your request only with the volunteer who is completing the delivery.

We are are prioritizing high-risk and under-resourced populations, but hope to provide support to everyone who makes a request. Please spread the word!

We are a volunteer group supported by the Sitka Conservation Society. This form is adapted from the Seattle Covid19 Mutual Aid network. We are grateful for their work and example.

Much love Sitka.
Name *
Your answer
How should we contact you? *
Please provide your phone number, email and/or Facebook messenger.
Your answer
Do you need supplies delivered, financial assistance or both?
Dietary Restrictions, Allergies, or Intolerances
Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock.
Your answer
How many people are in the household? *
Your answer
What types of food do you want? *
Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock.
Required
Grocery List *
We recommend buying in bulk to limit the number of grocery trips required. Items can be general like "milk," or specific like "a 24-pack of the purple Always brand overnight menstrual pads with wings." We will do our best to match your requests, but if we can't find something specific we may get you a similar substitute. We trust you to know your needs and we are committed to delivery without judgement.
Your answer
Do you need someone to pick up your prescriptions for you? If yes, which pharmacy?
Please either give a phone number/Facebook messenger option so we can reach you (this option is safer) - OR - include all relevant info here, like your legal name, date of birth, and the names of the medications (Google forms are not secure!).
Your answer
Do you have any other needs or requests?
Your answer
Do you need financial support? *
We can fund up to $50 of supplies per request (while funding lasts) for folks who have financial need.
Delivery address *
Please include instructions for where the volunteer should leave the supplies. We are providing doorstep deliveries, staying outside of people's homes.
Your answer
What day and time do you need things by? *
Please allow us 48 hours to respond to your request. *We can't guarantee timing, but will do our best.
Your answer
Any additional comments or questions?
Please let us know if you are high-risk for covid19 or facing financial or other barriers, so that we can prioritize your request (sick, elderly, immunocompromised, quarantined without pay, without childcare, etc.)
Your answer
Thank you!
We will try to let you know if we can meet your request within 24 hours. We're so glad you've reached out. Spread the word others who may need support and check in with social networks to make sure folks aren't isolated. Much love Sitka!
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy