Sri Lankan-NY COVID-19 Mutual Aid: Help Form

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To access non-emergency assistance, please complete the form below or call () and we will work as quickly as possible to come to your aid. Please note, that this is generally to provide support to our community in NY and if possible in other regions of the United States.

We all hope to keep the practices of kindness, gentleness, and mindfulness in mind throughout this time, and throughout this effort.

Email *

Name *

Phone Number *

Address

City

How did you hear about us? (ex: Facebook, Instagram, Friend, etc.)

What language is best for you to communicate in?

English

Tamil

Sinhala

Other:

Clear selection

Sensitive Information Handling

Some of the information required in the application for unemployment and health insurance requires exchange of sensitive information including and not limited to social security number, address, employer, tax information, etc.
- Our volunteers will be trained to not share or save any of this information
- This information will only be used for the application process
- The application process may take several days because of a website issues, please be patient!
- If you have any questions or preferences, please let us know by emailing collective.sl.si@gmail.com

Do you agree to the sensitive information handling as outlined above? *

Yes

Safe Delivery Agreement

- Recipients will make as minimal contact with the deliverer as possible upon delivery:
- They will place items at the door and knock/ring the doorbell and/or call the recipient to inform them that their order has been delivered.
- Items will be paid for prior to delivery or via cash in envelope as agreed to by store.
- Volunteers bear no responsibility to pay for items they are delivering.

*Note that our volunteers have limited availabilities*

Do you agreed to the safe delivery agreement as outlined above? *

Yes

I need help with (Select all that apply)

Grocery shopping and delivery

Picking up a prescription

Accessing health information

Applying for unemployment

Applying for health insurance

Understanding the current guidelines about prevention of COVID-19

Getting non-surgical masks

Other:

How urgently do you need this request filled?

Same day

Next day

Within the week

Within next two weeks

Other:

Clear selection

If you have any questions or concerns, please mention below:

Thank you and Be Well!

Any other questions, please feel free to email collective.sl.si@gmail.com

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