Upper Valley-Area COVID-19 Mutual Aid Volunteer/Needs Sign-up
This survey has been created by the Upper Valley Response Team (UVRT), a grassroots community network building systems of mutual aid. The purpose of this network is to help protect and support the Upper Valley community throughout the COVID-19 outbreak. By connecting volunteers with those in need, this network aims to reduce the spread of the virus by supporting all people to stay at home, particularly those with risk factors and those showing symptoms. Groups at high risk include people over 60, and those with underlying medical conditions, such as respiratory illness, heart disease, obesity, diabetes, and lung disease.

This form is appropriate for both those asking for and those offering support. If your need or availability changes, we ask that you resubmit the relevant fields of the questionnaire. Please know that we will not share any of the information you provide without first contacting you and obtaining your permission. By joining this network, you are agreeing that the group is not responsible for individual members' actions; the group's role is simply to connect individuals who want to support one another.

Though we recognize that practices of safe physical distancing are essential at this time, this need does not extend to emotional distancing. Indeed, bolstering our ethics of active community care has never been more important. Thank you so much for connecting with your community during this time of crisis.

Please feel free to reach us at uppervalleyresponseteam@gmail.com and via phone at (802) 727-0311.

For more information about UVRT or other resources, please go to www.transformationalpractice.org/covid
Name (and pronouns if you would like to share them) *
Your answer
Phone Number *
Your answer
Email *
Your answer
Where do you live? *
What is your address?
If willing to provide.
Your answer
Are you in quarantine? *
If you NEED ASSISTANCE, what services do you need? *
Please select the service categories that most reflect your needs. If you need to elaborate further on your situation, please use the "Notes" question at the bottom of this form.
Required
If you can VOLUNTEER, what services can you provide? *
Please select all service categories that you can volunteer for.
Required
Do you know of others who might require assistance? *
Required
Would you be interested in being part of a peer-to-peer emotional support network via phone or online platform? *
Are you interested in joining any of the following networks that build long-term community resilience?
If you would like to make a financial contribution to support those experiencing the impacts of COVID-19, please do so here: https://bit.ly/2U6RulX *
Note that 100% of your donation, minus processing fees, will go to Upper Valley people in need of assistance. The Center for Transformational Practice (www.transformationalpractice.org/) is accepting and tracking donations for this cause.
Notes
Please elaborate on your service requests or offerings here.
Your answer
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