Portland area COVID-19 "Request Support" Form
Please use this form if you would like food or other supplies delivered to you.
We are prioritizing folks who are sick, unhoused, disabled, quarantined without pay, elderly, undocumented, queer, refugees and immigrants, Black, Indigenous, People of Color, trans, and queer, including those displaced from Portland to the nearby areas. Thank you for your patience and grace.
We are an all-volunteer grassroots network operating in the territories of the many tribes who have made their homes near the confluence of the Willamette and Columbia Rivers, including Multnomah, Wasco, Cowlitz, Kathlamet, Clackamas, Bands of Chinook, Tualatin, Kalapuya, Molalla. This is a volunteer run effort, and we are utilizing the technology that is easiest and fastest for us. We cannot make guarantees regarding the security of your personal information, and as such you should be judicious about what you share. Any information passed through is at your own risk. We also cannot guarantee response to all requests.
Questions, comments, and updates can be found at:
If you're looking to Offer Support, that form is found at this link:
Let’s take care of each other. By us for us.
እርስ በርሳችን እንከባከብ። በኛ ለኛ።
Vamos a cuidarnos unes a otres. Por nosotres, para nosotres.
This does not need to be your legal name. Add your pronouns, too, if you want!
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How should we contact you?
Phone numbers for SMS Text is the easiest way for use to reach you. Please include your phone number, email, and/or Facebook messenger -- you can give several options if you'd like.
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Please help us be equitable in helping the community. Choosing less dire doesn't mean we won't get to you. We are trusting you to self-identify the urgency of your need using the examples in this scale:
I am completely out of food/meds, I have no community network or support, I am sick, I am immunocompromised
I am almost out of food/meds, I have little community network or support, I am or may be sick, I am or may be immunocompromised
I am not out of food, but worried I may be in 3-4 days, I have community network or support but not sure they’re available, I am worried I may be at higher risk
I am not out of food, but will be within a week, I have community network or support, I am not as worried about my risk but have other reasons to ask for help
I am not out of food, but will be within 2 weeks, I have community network or support, I am not worried about my risk but have other reasons to ask for help
Dietary Restrictions, Allergies, or Intolerances
Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock.
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What types of food do you want?
Ingredients to cook with.
Reheat and serve/frozen.
Low-prep (like macaroni, sandwiches, etc).
Are you interested in a food box from Oregon Food Bank?
Box will include 1-2 weeks of produce + non-perishable foods.
Items can be general like "milk," or specific like "a 24-pack of the purple Always brand overnight menstrual pads with wings." We will do our best to match your requests, but if we can't find something specific we may get you a similar substitute. We trust you to know your needs and we are committed to delivery without judgement.
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Do you need someone to pick up your prescriptions for you? If yes, which pharmacy?
Please either give a phone number/Signal/Facebook messenger option so we can reach you (this option is safer) - OR - include all relevant info here, like your legal name, date of birth, and the names of the medications (Google forms are not secure!).
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Do you have any other needs or requests?
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Do you need help covering the cost?
We can fund up to $50 of supplies per request (while funding lasts) for folks who are quarantined without pay, sick, disabled, elderly, undocumented, queer, Black, Indigenous, and/or people of color.
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Pay with your own money and donate to help others:
Pay with your own money (coordinate with delivery person)
Request support with your delivery items (up to $50)
Request support ($50) + pay with your own money for additional groceries over $50
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What neighborhood is this in?
Northwest Portland neighborhoods
North Portland neighborhoods
Northeast Portland neighborhoods
Southwest Portland neighborhoods
Southeast Portland neighborhoods
East Portland neighborhoods
East Suburbs (Gresham, Fairview, Troutdale, etc.)
South Suburbs (Milwaukie, Clackamas, Happy Valley, Gladstone, Oregon City, Lake Oswego, etc.)
West Suburbs (Beaverton, Tigard, Aloha, Hillsboro, etc.)
What day and time do you need things by?
We can't guarantee timing, but will do our best.
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Any additional specifications, comments, questions, accessibility needs, or drop off instructions?
How many people are in your household?
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Demographics: If you wish to share your demographics, it will help us know whether we are meeting our goals of equitable distribution. You may let us know if you identify as:
Sick and/or quarantined without pay
Undocumented, refugee, or immigrants (combined option for your security)
Black, Indigenous, or Person of Color
We are doing our best to answer requests as quickly as possible. As the situation develops we are ramping up our dispatch system but may be unable to keep up with needs. Thank you for your patience.
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