Bay Area Senior/Disability/Worker Mutual Aid Form
In the midst of the coronavirus crisis, communities most affected are coming together to support each other. Senior and Disability Action, Bay Resistance, and a variety of community organizations and labor unions are working to identify and meet the needs of seniors, people with disabilities and health conditions, and workers who are at risk in this moment.

Together, we can make sure people have access to food, medicine, and other necessities, and we can find ways to connect to each other and not feel isolated and alone.

This form will take about 5-10 minutes to fill out.

Please fill out this form if you (or someone you're assisting) are:
- an older person
- a person with a disability or with a health condition
- a worker in need
- an ally with time or resources to offer.

This form is for who both need and want to share aid as many of us are both.

You do not need to fill out this form multiple times- once we reach out to you, if you have additional needs or support to offer, please contact us again.

We will do our best to meet your needs. We will also work together to document the need in the community and ensure that systems do not leave marginalized communities behind.

Seniors and people with disabilities in San Francisco can call Disability and Aging Services at (415) 355-6700 or TTY (415) 355-6756 for referrals to services, including take-out meals, home-delivered meals and groceries, Community Living Fund, and more.

Esta forma en español:

Fortunately, a number of other networks are also offering mutual aid. To simplify our efforts, if you are asking for help, please do not fill out multiple forms. (If you'd like to offer help in multiple places, feel free!) Other mutual aid forms are listed here:
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