Seattle area COVID-19 "Request Support" Form
If you would like food or other supplies dropped off at your front door, please use this form. We are prioritizing folks who are sick, disabled, quarantined without pay, elderly, undocumented, queer, Black, Indigenous, and/or people of color -- including those displaced from Seattle to the nearby areas.

** Donate **

https://www.gofundme.com/f/covid19-survival-fund-for-the-people

** View this form in another language **

If you are able to do the form in English, that will help ease the load on our translators!

English (this one!): https://tinyurl.com/wk7zzla
Español (Spanish): https://tinyurl.com/ur2865g
አማርኛ (Amharic): https://tinyurl.com/vo9k5fm
ትግርኛ (Tigrinya): https://tinyurl.com/u2t8t7l
Tiếng Việt (Vietnamese): https://tinyurl.com/u9aflbu
中文 (Mandarin): https://tinyurl.com/tz7doy2

** Questions, updates or want to get involved? **

Facebook: https://www.facebook.com/covid19mutualaid
Instagram: @covid19mutualaid
Email: covid19mutualaidsea@gmail.com
Join the google group for announcements: mutual-aid-seattle@googlegroups.com
Volunteer with us: https://docs.google.com/forms/d/16ESS-9g9S58wpEGavsGu3aj6LnhvVYNdJJd-Qp_PfUY/viewform
If you have supplies to donate directly to our unhoused neighbors, please contact "this cold, cold world" on Facebook: https://www.facebook.com/This-cold-cold-world-101964174676844/

We are an all-volunteer grassroots group operating in Duwamish and Coast Salish territories. Thank you for your patience and grace.

** Other local efforts **

Tacoma Mutual Aid Collective (TMAC) request form: https://docs.google.com/forms/d/e/1FAIpQLScQLH-RwSCAVCAm310EF91j74mvjIG49Za0F__8Mb1S3ZFEwA/viewform

Eastside & South King County Mutual Aid Request Support Form: tinyurl.com/eastsidemutualaid

Snohomish County Mutual Aid Request Form: https://docs.google.com/forms/d/e/1FAIpQLSejPxLmXv2oNqYTTcqh37YSmr-kLPGfbdxFqo0hokqZLj9iqw/viewform

Skagit County Mutual Aid: https://docs.google.com/forms/d/e/1FAIpQLScziPY-6hzgFPCVUcMBbNMTWe19ROTqPdxjA7rdL2CHLxZ8rg/viewform

Let’s take care of each other. By us for us.
Hãy chăm sóc lẫn nhau. Bởi chúng mình cho chúng mình.
እርስ በርሳችን እንከባከብ። በኛ ለኛ።
Vamos a cuidarnos unes a otres. Por nosotres, para nosotres.
守望相助。
ነንባዕልትና ንተሓባሐብ። በባዕልትና ንባዕልትና።
Name *
This does not need to be your legal name. Add your pronouns, too, if you want!
[Image is a red name tag that says "Hello my name is" with nothing written in the blank space.]
[Image is a red name tag that says "Hello my name is" with nothing written in the blank space.]
Your answer
How should we contact you? *
Please give several options if possible.
[Image is a sketch of a smartphone open to a home page with many apps.]
[Image is a sketch of a smartphone open to a home page with many apps.]
Your answer
What is your phone number?
Please include your area code. Leave this field blank if you do not have a phone number.
Your answer
What is your email address?
Leave this field blank if you do not have an email.
Your answer
How many people are in your household?
[Image is a photo of three people sitting on a couch, embracing. The person in the middle is laughing while being kissed on the cheek by both people on either side of them. The person on the left has orange locs, medium skin tone, and a pink shirt. The person in the middle has black hair, dark skin and a plain white T-shirt. The person on the right has straight black hair, dark skin, and a blue shirt.]
[Image is a photo of three people sitting on a couch, embracing. The person in the middle is laughing while being kissed on the cheek by both people on either side of them. The person on the left has orange locs, medium skin tone, and a pink shirt. The person in the middle has black hair, dark skin and a plain white T-shirt. The person on the right has straight black hair, dark skin, and a blue shirt.]
Your answer
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.
[Image is "Mr. Yuk," a disgusted looking green emoji. The emoji is surrounded by a thick black outline, which has the words "Yuk!" and "Stay away!" written on it in all caps.]
[Image is "Mr. Yuk," a disgusted looking green emoji. The emoji is surrounded by a thick black outline, which has the words "Yuk!" and "Stay away!" written on it in all caps.]
Your answer
What types of food do you want?
Grocery List *
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.
[Image is a person with very curly brown hair, medium tone skin, a pink jacket, a yellow purse, and blue jeans pushing a grocery cart full of groceries: many bottles and bags of different sizes and colors.]
[Image is a person with very curly brown hair, medium tone skin, a pink jacket, a yellow purse, and blue jeans pushing a grocery cart full of groceries: many bottles and bags of different sizes and colors.]
Your answer
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!).
[Image is an orange pill bottle with a white lid and a sticker that says "Rx" in blue, illustrated to look as if there are more lines of text. The background is a teal circle.]
[Image is an orange pill bottle with a white lid and a sticker that says "Rx" in blue, illustrated to look as if there are more lines of text. The background is a teal circle.]
Your answer
Do you have any other needs or requests?
[Image: two hands reach to touch one another, with fingers curled to create a heart shape. The hand on the left is dark skinned; the hand on the right is medium skin tone.]
[Image: two hands reach to touch one another, with fingers curled to create a heart shape. The hand on the left is dark skinned; the hand on the right is medium skin tone.]
Your answer
Would you like financial support? *
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.
[Image is drawing of a stack of three wads of green bills.]
[Image is drawing of a stack of three wads of green bills.]
Delivery address *
[Image is a light orange cartoon house with two blue windows, a brown door, a red roof, and red heart-shaped smoke coming out of the orange chimney.]
[Image is a light orange cartoon house with two blue windows, a brown door, a red roof, and red heart-shaped smoke coming out of the orange chimney.]
Your answer
What is your 5-digit zip code? *
If you don't know your zip code, or if your actual zip code isn't working, please use 98000.
Your answer
If you live outside of our service area, can we send your request details to another local mutual aid organization who we trust? *
If you say yes, it will be will be faster and simpler to get you your delivery! If you say no and you live outside of our range, we will let you know that we can't help you and tell you where to go to find help for your location, which may take a while, and then you will have to fill out another group's form and begin the whole process again from scratch. (We will never share your information with advertisers, political candidates or parties, corporations, or the government.)
What day and time do you need things by? Please allow us 48 hours to respond to your request. *
We can't guarantee timing, but will do our best.
[Image is a cartoon of a blue clock and a red calendar on yellow background.]
[Image is a cartoon of a blue clock and a red calendar on yellow background.]
MM
/
DD
/
YYYY
Time
:
Any additional specifications, comments, questions, accessibility needs, or drop off instructions?
Your answer
Do you have skills you would be willing to provide to others?
In the near future, we are considering expanding the types of mutual aid we offer. These might include emotional support, household chore assistance, childcare, dog walking, etc. Please note access details when possible, like: are you able to be scent-free (http://thinkbeforeyoustink.com/howtogofragrancefree.html)? Can you speak several languages, or sign languages? Do you have a wheelchair accessible van?
Your answer
We will try to let you know if we can meet your request within 48 hours. We're so glad you've reached out to us for support.
Drawing from the brilliance, love and creativity we have for each other and looking to learn from those showing solidarity globally, including those in Wuhan, China, we aim to cultivate a politics of autonomy, solidarity, and mutual aid within a long-term, multi-generational horizon of decolonial, anti-capitalist, feminist, queer, and disability liberation.

No body is disposable.

Close all prisons, jails, juvies and detention centers now!
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