Allegan & Ottawa Mutual Aid Form
Please fill out the below form to the best of your ability, so that we can obtain the information necessary to help you. Please email westmimutualaid@gmail.com with any questions.

Join this Facebook group to stay informed about our efforts and resources:
https://m.facebook.com/groups/1083718001989995/

**Right now we are only able to provide help in Allegan and Ottawa County

**IF YOU ARE IN A RISK CATEGORY, PLEASE KEEP YOUR OWN SAFETY IN MIND IF OFFERING HELP**
Name *
Phone Number *
Email *
Age *
Zip Code (right now we are only able to provide help in Allegan and Ottawa Counties) *
Are you requesting a need (for someone to pick up groceries for you, emotional support) **NOTE: WE CANNOT PROVIDE HOUSING. IF YOU ARE HOUSELESS AND IN NEED, PLEASE REFER TO THIS LINK: https://www.mi211.org/get-help/housing-shelter OR CALL 2-1-1. *
If offering a resource, what can you offer?
Are you in a risk category (immunocompromised, chronic condition including asthma, hypertension, diabetes, etc.)? *
Do any of the following apply to you? **Please answer honestly. We will not ignore you based on your response to this. We just need to know so we can act accordingly. *
Required
If you are in the Allegan & Ottawa County area, join this Facebook group to stay connected to ongoing efforts and resources: https://m.facebook.com/groups/1083718001989995/ *
Anything else?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy