Ukrainian Village/West Town Mutual Aid Intake Form
Haga clic aquí para la versión en español: https://docs.google.com/forms/d/e/1FAIpQLSdhImLsJKIRBYFFeNsPxUbROXurDzgfFGsVBwWlGrOw2JESTg/viewform

If you or someone you love is elderly, immunocompromised, needing support, and/ or financially struggling due to COVID-19 Ukrainian Village Mutual Aid is here to help you. If you're here to connect with others in the neighborhood and provide help when you can, we're here for that too.

We are an all-volunteer grassroots neighborhood collective in Ukrainian Village. We are not a food pantry, large non-profit, charity organization, government agency, or private corporation with millions in the bank. We can't promise every request will be fulfilled, but we will do our best - as neighbors helping neighbors! Please allow up to one week for a response.

We are prioritizing folks who are sick, have compromised immune systems, disabled, quarantined without income, economically disadvantaged, elderly, undocumented, queer, people of color, and/ or families in need.

New requests will be granted highest priority. We will do our best to honor repeat requests with the resources we have available.

If you live outside of UKV, there are many neighborhood groups doing the same work we are - Lincoln Square/Ravenswood Solidarity Network, Edgewater Solidarity Network, Little Village Solidarity Network, Pilsen En Defensa, Rogers Park Solidarity Network, and Rogers Park Food Not Bombs. Feel free to contact them directly, or if you need help about where to look, let us know and we can do our best to get you in touch with the right people.

Your information is confidential and will absolutely not be shared for any purposes other than those you indicate below.
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Name (& pronouns if you want to share) *
Cross streets *
What is the best way to contact you? *
What is your email address?
What is your phone number?
How many people are in your household? Please include details of how many adults and children.
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