OFFERS: Mobilize Katahdin
Please fill out this form if you are able to OFFER support in response to the COVID-19 crisis. Your information is confidential and will only be shared with key organizers.

If you would like to REQUEST aid, fill out this form instead:

If you have any questions or to learn more about who we are, visit our website at, call us at 207-370-1581.
Your first name *
Your last name *
Phone number *
Email address *
Best way to contact you *
What type of aid can you provide? Check all that apply. *
Do you consent to a background check? If yes, provide your full name, any previous names you have used, and your date of birth. *
Are you able to cover the costs of groceries or supplies and get reimbursed afterwards? *
Do you have reliable transportation to make deliveries? *
How far are you willing/able to travel to make deliveries? *
If you have offered to make deliveries, what town do you live in?
Do you know of anybody that may need help that we should check in on? If yes, what is their name and contact information?
Questions, comments, or more information
If you checked that you could provide child care or pet care, please write how many children/what age children you can care for or how many animals/what kind of animals you can care for, and any other relevant details.
Never submit passwords through Google Forms.
This form was created inside of Millinocket Memorial Library. Report Abuse