Everett Community Aid Network – Needs & Support Form
This form has been created to match people who need support with people or agencies who can provide support in response to COVID-19. Your full responses will only be visible to the Everett CAN group coordinators and will be kept confidential. Your contact information will only be used to coordinate responses to community needs.

After submitting, please check your email for a message from us that includes our full resources listing and our contact information. These resources are updated on a monthly basis. If the emailed listing does not have what you are looking for, please respond to the email with your specific circumstances and request, and we will try our best to connect you with a resource that can help. If there is a need that you think a neighbor could help you with (baby clothes, grocery shopping, etc.), please post on our Facebook page letting the community know what you need. If you know of someone in need and can help coordinate assistance, please feel empowered to post that on our shared page as well!
Facebook Page - https://www.facebook.com/groups/220072455722934/
Sign in to Google to save your progress. Learn more
First and Last Name *
Phone Number *
Email Address *
Home Address (please include house/apartment number, street, and city) *
I prefer to be contacted by *
What is your preferred language? *
I am currently in need of help with
If you are currently in need of help, please answer the following
Yes
No
Do you have a child enrolled at an Everett Public School?
Are you a senior citizen, or have a senior citizen living in your home?
Have you or anyone in your home tested positive for COVID-19?
Do you have access to a vehicle?
Clear selection
I can help neighbors by
If you are fluent/conversational in languages other than English and can help us translate or interpret for your neighbors, please check here
Would you like more information on becoming a Neighborhood Point Person (NPP)? This means you’d be the “hub” for weekly food and supply deliveries that you would then take to those in your neighborhood that are in need. *
Have you contacted any other agencies or groups for help (for example, Everett 311, churches, other mutual aid groups, etc.)? *
Please explain which groups or resources you have reached out to and your experience:
Please add any additional relevant information here
How did you hear about us?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms