Bay Area Senior/Disability/Worker Mutual Aid Form

Esta forma en español:

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 re 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. You only need to fill out this form one time - once we have established contact with you, you will be able to contact us directly if you have additional needs or support to offer.

This form is for both those in need and those who want to share aid, as many of us fit both categories.
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

What sort of mutual aid can you expect?

We are mostly coordinating deliveries of food, medicine, and supplies for people who are advised to remain home and/or are unable to leave their home. We are also setting people up with phone partners to check in on each other. To a limited extent, we are also coordinating in-home support.

This mutual aid project is staffed by volunteers and it belongs to all of us - we all have a responsibility to each other.

If you do not need a delivery (you are healthy, you are able to go to stores, you are able to prepare your own food, and/or you do not live with someone who is immuno-compromised or otherwise at increased risk), we can help you connect to other resources. Please also explore the resources that we have consolidated and will continue to update here:

We are not able to provide intensive support, but we may be able to help you determine which resources to contact, especially for financial and for food assistance.

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

Esta forma en español:
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