North Valley Mutual Aid - COVID19 - VOLUNTEER FORM
We are coordinating food and supply drop offs to people's front doors. Please use this form if you would like to help make deliveries. Thank you!!

We are prioritizing folks who are sick, disabled, quarantined without pay, elderly, undocumented, queer, trans*, Black, Indigenous, and/or people of color. Thank you for your patience and grace.

Please make a check next to all potential supports that you have the capacity to provide. All offers of support will be kept confidential until a need arises. These are non-binding, but more to get a sense of the abundant resources we do have. At the end, please also tell us about potential situations where you might need assistance, so we can start to match up potential needs with potential offers.

Questions, updates or want to get involved?
Facebook: https://www.facebook.com/northvalleymutualaid
Email: nvma@riseup.net
Join the google group for announcements: mutual-aid-community-response@googlegroups.com
Request support: https://forms.gle/2eVZQ4jQQDrXWEXf6

If you'd like to help, please see this survey results google doc link below and mark you name in column Q if you are going to contact to help that person: https://docs.google.com/spreadsheets/d/1T5kx7dVOYwDJ6wRhcGopbaA6hAiSTMrGr0G747brrYQ/edit?usp=sharing

A Chronic Illness Patient's Guide to Coronavirus:
https://awareness.creakyjoints.org/coronavirus/?link_id=3&can_id=490ba7e62bd1d59cd488c422899b7f99&source=email-when-every-community-is-ground-zero&email_referrer=email_749340&email_subject=when-every-community-is-ground-zero

Thank you!
Email address *
Name/Pronouns *
This does not need to be your legal name. And add your pronouns if you want too!
Your answer
How should we contact you? *
Please include your phone number, email, and/or Facebook messenger -- give several options if possible.
Your answer
Do you have access to a vehicle? *
                                                                [Image of a red cartoon car]
[Image of a red cartoon car]
I can provide the following supports: (Remember, this is non-binding. Please check all that apply) *
Required
Are you 21+ with a valid ID? *
           [Image of an ID Card with the face of Spongebob on it, and Bikini Bottom as the State]
[Image of an ID Card with the face of Spongebob on it, and Bikini Bottom as the State]
Would you like to help pay for the groceries / supplies?
We want to ensure that those who want to provide mutual aid do not face undue burden and we absolutely do not expect you to spend money if you are financially limited.
What type(s) of money transfer work for you?
If you marked any meal prep options above, please list any particular cuisines that you are used to cooking (e.g. Somalian, Italian, Vegan)?
Your answer
What neighborhood or town do you live in?
Your answer
What languages do you speak?
Your answer
Where do you prefer to deliver?
                                       [Image: Map of Butte County listing towns in the area]
[Image: Map of Butte County listing towns in the area]
Do you have any accessibility needs you want to share, or need anything else to feel safe providing deliveries?
Generally, what times are you available?
You may also leave more specific day and time schedules in the "Other" write in box.
Any additional specifications, comments, or questions?
Your answer
Thank you again for taking time to fill out a support form! We will contact you if and when we match you with a request.
Your answer
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