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Queer Disability Aid - Request Form
Hi, I’m Umi (they/them) and am looking to help out queer disabled folk. Fill this out if you are a queer disabled person in need of assistance!
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Name / Pronouns
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Your answer
What task do you need help with? Examples: cooking, cleaning, grocery shopping, moving furniture, misc. physical tasks, etc.
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Your answer
What days/times are you available?
The more times you put, the better!
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Your answer
What neighborhood are you located in?
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Your answer
Instagram username
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Your answer
Phone Number
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Your answer
We offer our services on a sliding scale basis. If you can’t afford to pay, feel free to put N/A (not applicable). We won't turn anyone away for not being able to pay. If you are in a position to pay, know that your money makes it possible for us to bring support to those who need it.
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Your answer
How did you hear about us?
Your answer
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