SE Como Offer of Support
This form will be used to match volunteers offering support to individuals seeking support.
What is your name and preferred pronouns?
Please provide your phone number (Is texting okay?)
Please provide your e-mail address
Are you interested in staying up to date on programs and services offered by SECIA and around the neighborhood, by receiving our bi-weekly newsletter?
Can we contact you to connect you with someone looking for the following resources? (Check all that apply. Checking any or all of these boxes does not obligate you to provide support when asked. If you are not feeling well or are a member of an at-risk population, please keep yourself safe and healthy)
Food - I am available to deliver groceries
Supplies - I have basic supplies (hand sanitizer, paper products, etc)
Appointments - I am able to bring someone to and from appointments
Dog - I would love to walk someone's dog
Talk - I am able to chat with via phone, e-mail, or video
Financial Support - I know of an organization that can provide financial relief or can provide it myself (please provide more details below)
If you know of an organization that can provide financial relief or are able to provide it yourself, please provide information so we can connect people with the resources that will best meet their needs
Any additional help you would like to provide that was not listed?
Who are we reaching?
The following questions will help us understand who we are reaching, they are completely optional and will not be used to determine the matching of support to those who need it.
Are you affiliated with the U of M?
I am a student
I am an employee/staff/faculty member
I am not affiliated with the U of M
What best describes your age?
under 18 years old
18 - 24 years old
25 - 34 years old
35 - 60 years old
60 years or older
Do you identify as Spanish, Hispanic, or Latinx?
I identify as Spanish
I identify as Hispanic
I identify as Latinx
I do not identify as Spanish, Hispanic, or Latinx
How would you describe yourself? (Check all that apply)
Where did you find this survey?
Flyer in the neighborhood
Never submit passwords through Google Forms.
This form was created inside of SECIA - Southeast Como Improvement Association.