Putney Mutual Aid - Confidential Needs and Offerings Form
Hello Neighbors,

A group of Putney neighbors has coordinated a Mutual Aid toolkit for community use in response to the COVID-19 crisis.  

The toolkit includes:
1.  Putney Mutual Aid Resource Sheet -- statewide resources for folks needing support: https://bit.ly/PutneyResourceDoc

2.  UPDATED!  Putney Mutual Confidential Needs and Volunteer Survey -- allows you to communicate your need confidentially and protects your data

SAFETY: To reduce transmission of COVID-19 the State of VT has asked us to stay at home and keep social distance of 6 feet. If we go out of the house, we are asked to wear a mask, maintain distance, avoid going into anyone's home, and wash our hands before and after. Volunteers are being asked to follow Vermont Public Safety instructions to keep everyone safe and healthy.  https://vem.vermont.gov/neighborly

NOTE ON SAFETY OF PUBLICLY-SHARED DATA: If you have already provided Putney Mutual Aid with information on your needs and/or volunteer offerings using a previous survey and a shared public google sheet, we have have your information and no need to resubmit!  Any personal information that had previously been shared in a public document has been removed from public access.

Please complete the below form to indicate your need or ability to volunteer. Fill in as much or as little as you would like, but know that the more you can provide the better we can work to find you a volunteer match.

Volunteers on the Putney Mutual Aid Team will do their best to match you with a neighbor who may be able to help. In some cases, this may be someone who has self-identified as a point person in your neighborhood. By completing this survey, you give permission for the Putney Mutual Aid Team to share your information with Putney Mutual Aid Volunteers and organizations that may be able to help you.

If you have any urgent concerns and wish to reach Emergency Management Director Tom Goddard, you can contact him directly [802-387-4372; 802-579-9526; or via email at chief@putneyvt.org]. If you are interested in connecting directly with the Putney Foodshelf please email covid19putneyfoodshelf@gmail.com or call 802-387-8551.

Lastly, if you know someone who is not online and/or would find it difficult to fill out this survey, please have them contact us and we can do this over the phone. You can send an email to the address listed below or contact either Jaime Contois [603-504-2906 (cell)] or Ruby McAdoo [802-839-9789 (cell)] for assistance with this confidential survey.

Be well and stay safe,

The Putney Mutual Aid Team
PutneyVTMutualAid@gmail.com
Sign in to Google to save your progress. Learn more
What is your full name? (and pronouns if you want to share them) *
What is your email address:
What is your preferred telephone number?
Do you have a telephone number that we can use to text you? If so, put it here.
Where do you live in the Putney Area? (You can be specific with a street address, just give the road name or give a general area of town)
Do you believe you are particularly vulnerable during this COVID-19 crisis? If so, please provide more information below (ex. single parent, taking care of loved ones with medical needs, feeling isolated/alone and needing a check in, caring for a pet)
Do you have a need?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy