Homemade Mask Request Form - Howard County COAD
Please note: Submission of request does not guarantee delivery of mask.
* We will do our best to address your request within 7 days of submission.
These masks are homemade. N95 & KN95 masks requests cannot be filled via this form.

Face masks can be purchased online from a wide variety of retailers and vendors. You can also find tips on how to make your own face covering at home, using both sew and no sew options, on the CDC's website at https://bit.ly/2V9fNjY.

If you are a low-income, elderly or otherwise vulnerable Howard County resident who has no other way of acquiring a face covering, you can submit a request via this form.

If individuals or groups want to make face coverings to donate and share with the community, please email COAD at masks.hocoad@gmail.com.
First Name *
Last Name *
Email Address *
Number of Adult-sized Masks Requested *
Number of Child-sized Masks Requested *
Address for Mask Delivery (MUST provide house number, street, and city) *
Zipcode *
Identifying features of delivery point (ex. green shutters, last house on right). If an apartment complex, please include floor, or description of building front entrance, etc. *
I acknowledge that I am a Howard County Resident using this form to request a homemade mask because I have no other means of acquiring, buying, creating, or ordering a mask. *
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