CONTRA COSTA- Aid Request Form

The idea behind this is to crowd source some mutual aid for folks in the SF Bay Area, who are affected by Covid-19 or the current situation. You may be immune-compromised, chronically ill, asthmatic, or in another kind of high risk group. You may also be quarantined for some reason and need help. If you need help, this is a non-judgmental place to ask for help and hopefully get it.

If you are in need, please fill out the following survey. The information you provide will be posted PUBLICLY (within our community) to a google doc that will be shared so folks can contact you if they are able to help. We do not ask for your name to maintain privacy before accepting the aid.

If you'd like to help, please fill out this form and we will reach out to you once we've found a good match: https://airtable.com/shrOvUwUKyuN6zyqv.

DISCLOSURE: The host of this document cannot guarantee that all requests for aid will be met but is simply a community member offering to share a document and allow others to help each other. Please be responsible when arranging things with folks you have not met. The host accepts no liability around these arrangements.

Please email SFBayAreaMutualAid@gmail.com to have any information removed or changed. This was adapted from the Seattle Queer Mutual Aid Google form, thank you Seattle!
* Required

Are you over the age of 50? *

Yes

Clear selection

Do you have a chronic health condition that affects your immune system? *

Yes

Other:

Clear selection

Have you had a fever or flu like symptoms in the last week? *

Yes

Other:

Clear selection

I am seeking assistance with.... *

Picking up and delivering groceries, medicine or other essentials

Transportation to medical facilities (to avoid public transportation and ride shares)

1 on 1 Phone Calls / Video Chats / Home Visits / Companionship

Pet Care

Extra medical supplies (list below in OTHER)

Mental Health Support

Cleaning supplies or essential items while out of work / income reduced

Home cooked meals

Home / Apartment Cleaning

Assistance navigating and advocating to social services

Child care

Funds

Virtual Meetups

Clear selection

Please provide a phone number or email for those that would like to help to contact you. *

Do you have reliable transportation? (this is not a requirement)

Yes

Other:

Clear selection

Location (Neighborhood) * *

Instagram/Twitter/Venmo handle

Any other comments, questions or concerns?

Submit

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