Materials Donation Form for COVID-19 Pandemic
This form is designed so that you can submit your donation to the Houghton and Keweenaw county Emergency Operations Center who are managing donations for the five County region. We will contact you and set up a time to pick up your donated materials and gather other relevant information related to this. Items donated will be distributed to hospitals, local law enforcement, first responders, fire departments, nursing homes, and other applicable organizations. Donations will be distributed in order of need. Please note that donations will be distributed to the county of which you live in.

Please submit a separate form for every unique item.

Examples of items:
Face shields, 3D printed face shields (must be approved designs from the National Institute of Health - https://3dprint.nih.gov/collections/covid-19-response)
Medical grade gloves, latex free
N95 or KN95 masks
Surgical masks
Bleach wipes
Hand sanitizer

If you have any questions please contact Darian Reed (dsreed@superiorsar.org)
County *
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Donated Item *
Your answer
Quantity *
Your answer
Unit *
Approximate Value Per Unit *
For homemade goods such as 3D Printed items or face masks please include a value for each item. Include Material cost and time spent on making the item. For other items such as store bought materials, please list the value of the item purchased.
Your answer
Comments
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Michigan Technological University. Report Abuse