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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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Email
*
Your email
Organization name
Your answer
Contact name
Your answer
What is the size of your business in terms of number of employees?
Your answer
Where do you have a presence geographically?
Globally
Nationally
In a subset of states (please list below in "other")
Other:
Clear selection
What need area are you are working on or would like to work on?
Increase Supply of Medical-Grade PPE in Shortage for Hospitals and Medical Professionals
Bridge Gap Financing to Get PPE to Those Who Need it Faster
Share Data to Help Connect PPE Supply to Demand
Outfit America’s Workforce & Public with Reusable Cloth Masks Made in the USA
Other:
What impact have you achieved so far if any? Please include metrics where possible.
Your answer
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.)?
Your answer
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.)?
Your answer
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)?
Your answer
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.)?
Your answer
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