Greensboro & Stannard Stay Connected & Mutual Aid Form
Our community can't help if we don't know how!

We have created this form to:
- Collect contact information to provide critical notifications and rapid response
- Identify volunteers for service coordination
- Identify needs that anyone may have now or in the near future

Please fill out all relevant sections and share widely. If you know someone who is unable to access internet, please fill this form out on their behalf! (Hard copies are also available at Willey's, Smith's, or by request).

For updated information regarding Town services and COVID-19 Response, please visit www.greensborovt.org or contact Greensboro Town Clerk, Kim Greaves at townclerk@greensborovt.org or 533-2911.

The Greensboro Stannard Neighbors Network is here to help! email greensborostannardneighbors@gmail.com or call the 24-hour local helpline 802-441-5225 with any questions!

For questions or help with the form, please contact Naomi Ranz-Schleifer at nranzschleifer@gmail.com or c.802-535-8090.

Please visit the town website WWW.GREENSBOROVT.ORG for updated information and Emergency Response Team contact info.
Name (and pronouns if you wish to share): *
Your answer
Phone Number (or N/A if you don't have one) *
Your answer
Email Address (or N/A if you don't have one) *
Your answer
Preferred Contact Method *
Required
Address
Your answer
How many people are in your household?
Your answer
Are you available to help, seeking help, or both? *
Do you need assistance having supplies/food delivered? (Call Willey's and Smith's Stores for specific shopping needs. Volunteers will assist with delivery.)
If yes, what supplies are you in need of?
Your answer
Are you 60 or older and in need of meal assistance?
Are you under the age of 60 and in need of meal assistance?
Are you in need of child care?
Are you in need of mental health support?
Is there anything else you would like your volunteer to know?
Your answer
Do you work in health care or other essential fields?
Would you like to be contacted about volunteer opportunities that involve picking up supplies, such as groceries, from stores or other businesses and transporting those materials to volunteers for distribution, or to the front steps of quarantined households? Please note that people receiving deliveries will be responsible for coordinating with you to reimburse you for supplies.
Would you be able to check in with neighbors via phone or online platform to help those in isolation?
Would you be able to assist with child care?
Would you be willing to share basic human needs like food, water, medical supplies, herbal medicine, hygiene products, etc.? Please indicate what you think you have to share. (It's okay if you don't know at the moment or if you don't have extra resources on hand.)
Your answer
Do you have special skills or particular resources you would like us to know about?
Your answer
Could you offer someone any temporary work?
Would you like to receive email notifications from the Town Clerk: *
Please let us know if you have any other questions or concerns at this time and we will have the appropriate person reach out to you!
Your answer
Thanks for helping our community get organized in response to COVID-19. After you submit this form you will be included in an information dissemination list and if you have a need or offer, someone will follow up with you. Our top priority is making sure that all community members remain safe and healthy and have what they need to enable them to stay home. Thank you for taking care of each other right now and doing your part!
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