Gifford Park & Joslyn Castle COVID-19 Care:  What are your needs? ¿Qué necesita?
*espanol abajo

This form is to gather information from folks whose immune systems are compromised and need support during this time. Please reference the community support offerings spreadsheet to see if there are community members who are offering the services you need already:

https://docs.google.com/spreadsheets/d/1q97dnlPb1EbeYk3QsBPk3MkV8Umbi5yQHFJrlqdwhKU/edit#gid=1958128353

The mutual aid support network will do their best to get you connected to your Neighborhood Point Person (NPP) or local resources.

Este formulario es para recopilar información de personas cuyos sistemas inmunes están comprometidos y necesitan apoyo durante este tiempo. Consulte la hoja de cálculo de ofertas de soporte comunitario para ver si hay miembros de la comunidad que ya han ofrececido los servicios que necesita:


https://docs.google.com/spreadsheets/d/1q97dnlPb1EbeYk3QsBPk3MkV8Umbi5yQHFJrlqdwhKU/edit#gid=1958128353



Sign in to Google to save your progress. Learn more
Name / Nombre
*this does not have to be your legal or full name. include your pronouns if you'd like!
What do you need? ¿Qué necesita?
Clear selection
How should we contact you? ¿Cómo le podemos contactar?
Clear selection
Address - Dirección de casa
*this will not be shared publicly *este no sera compartido publicamente
Phone number - Número de teléfono
*this will not be shared publicly *este no sera compartido publicamente
Email address - Correo electrónico
How urgently do you need it? ¿Qué tan urgente es su necesidad?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms