C19 Coalition Interest Form
Please fill out this form if you are a business leader interested in leveraging your assets to reduce critical PPE shortages alongside other members of the C19 Coalition
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Organization name
Contact name
What is the size of your business in terms of number of employees?
Where do you have a presence geographically?
Clear selection
What need area are you are working on or would like to work on?
What impact have you achieved so far if any? Please include metrics where possible.
What are you are hoping to achieve in terms of impact (e.g., specific localities you want to work with, populations you aim to help, etc.)?
What assets or capabilities do you have to contribute (e.g., FDA-approved medical supplies, material science/product design expertise, willingness to offer manufacturing support, on-hand raw materials, logistics/distribution support, etc.)?
What is the scale of impact you are aiming for (e.g., estimate of scale of units you could produce per week; number of trucks you could deploy to move materials, time from FTEs who have expertise you could offer)?
Where do you need help to have greater impact (e.g., need access to specifications, need guidance on PPE in greatest demand to focus, etc.)?
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