Community Support Sign-up
Thanks to the generosity of the City of Albuquerque, we were able to secure funding to provide COVID-19 response in the Black Community. We aim to use the funding to help both Black owned restaurants and the Black community.

This sign up sheet is for those who are suffering from food insecurities due to COVID-19 and to find out what other needs we can help with.

Questions? Email
Sign in to Google to save your progress. Learn more
Email *
Please choose how you identify *
First and Last Name *
Phone Number
Address: This will be used to mail gift cards and or deliver supplies. Your information will not be shared with anyone else. If you are not comfortable giving you address, we have volunteers who can meet you.
Preferred Contact *
Community Segment *
Please tell us about your need. (Examples include: help picking up medications, food need help finding childcare, need help picking up food items.) *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy