Free Mask Request Form
To help combat the mask shortage we’re currently experiencing, a network of volunteers has formed to sew homemade masks. Resilience Dayton, Dayton Sewing Collaborative, YPR Columbus, Mutual Aid Dayton/Miami Valley, Harm Reduction Ohio, Black Rose Collective, and others are collaborating on this effort. Any hospital, nursing home, senior housing facility, homeless shelter, clinic, doctor’s office, home care service, jail, group home, volunteer organization or anyone working with vulnerable populations may request homemade masks. We will distribute masks as they are available. We are working out of Dayton, OH but if you need masks and see this form, fill it out and we’ll either handle your request ourselves or get your information to a group in your area.

Please tell us about your organization and your needs. Someone will contact you soon to verify your needs and make arrangements to get you a mask.
Email address *
Your Name and basic contact information (Phone number or email address) *
Your answer
Name of Organization *
Your answer
City and State of Organization
Your answer
Name of manager or other point of contact in organization and their contact information (phone number or email address)
Your answer
What type of Organization needs mask?
How many masks do you need?
Your answer
Do you have any specifications for pattern or materials? Please include links or you may provide these when we follow up with you.
Your answer
Do you need other equipment such as face shields, hats or gowns?
Your answer
We’re looking for a local facility with an autoclave, UV sterilization or other sanitizing process so we won’t have to mail them. Can you help us with sanitizing and disinfecting these items before we send them out?
Your answer
Would you like to volunteer or make a donation to help with this project?
Your answer
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