NYC Face Mask Initiative
This form is used to request handmade face masks for frontline workers in the NYC area -- in hospitals, clinics, food banks and any emergency services.
If you're not in the NYC area, please submit anyway. We will do our best to fill your request as our effort expands.
THANK YOU for the work you are doing to keep our city safe and healthy
Your phone number
Name of hospital / organization you are requesting for
Street address of drop-off location
Borough of drop-off location
How many masks do you need? PLEASE provide a number or a range. Please only request what you need for the next 2 weeks so we can priority requests by urgency and have enough funds/ PPE for orgs not getting any support or funding for PPE.
How low in supplies are you?
We currently have n95 masks, but expect to run out soon
We are on n95s and rationing
We only have cloth or surgical masks
We have none and are in dire need
If you are not the contact person to receive supplies, please list the name, email & cell phone number of the person who is
Anything else we need to know?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service