Peoria COVID-19 Gifting Form
Thank you for your interest in helping others during this unprecedented crisis!

We are a Peoria-based Mutual Aid Network of concerned and caring citizens who want to prioritize the needs of traditionally marginalized people who are in most need of aid. We see this as a time to lift each other up and create new lines of support to build strong resilient communities.

Please fill out this form and someone on our team will contact you about next steps!
Email address *
Name *
Your answer
Pronouns
Your answer
Phone Number *
Your answer
DONATING MONEY
If you want to give direct financial donations, visit the Financial Needs List. If you want to donate to someone, enter the ID number from the column on the left in the field below, and someone from our team help you donate directly to them either through a gift card or by sharing pay pal/cash app information.
https://docs.google.com/spreadsheets/d/1QGEvKWX7OepekNSt1k1e8sA3HFwQCMoY7G49Z1qfXDQ/edit?usp=sharing

What is the ID number of he person you want to donate money to?
Your answer
DONATING FOOD/GOODS
These next few questions relate to donating food or goods. This might include perishable or non perishable food, household items, cleaning supplies, hygiene products, or even gifts cards. Anything that our team can pick up from you, and deliver to a person in need.
List what items you have to provide. Be as specific as possible, giving quantity, package size, and expiration date if possible. For example, "2 - 15 oz cans of Busch's baked beans with bacon", or "1 gallon of Prairie Farms 2% milk - expiration date April 12", or "1, 24-pack of Pampers diapers, size 3".
Your answer
Address
Your answer
How long can you keep the item(s) in your house? (we might not have someone who needs it right now, so let us know how long you can keep it, so we know whether we should contact you when the need arises.
Your answer
DONATING TIME
COME JOIN OUR TEAM! We are trying to build a strong and diverse mutual aid network in Peoria. These next questions are for people who want to join our team and help out.
Why do you want to join?
Your answer
Is there a specific community whose needs you want to work with us to address?
Your answer
Are you able to pick up items from givers, and drop them off for people in need?
What times are you available? *
Your answer
Do you have any special skills or abilities? (Speak languages other than english, medical or mental health practitioner, etc?)
Your answer
Do you have any other ideas or things you'd like to help us do?
Your answer
Check this box to confirm that you will only use any information provided to you through this program to help others who are in need, *
Required
Do you know of any resources or COVID-19 aid that the public should know about?
Your answer
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