COVID Mutual Aid WNC Organizer/Volunteer Intake Form
First Name
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Last Name
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Email Address: *
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Phone Number:
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Can we stay in touch through our Co-operate WNC email newsletter? During the Covid crisis, our newsletter is going out weekly with sharing of key information, announcements of events and trainings, and ways for you to participate in a range of mutual aid activities. *
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How do you prefer to be contacted?
Street Address
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City
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State
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Zip Code *
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When the information you provide on this form is shared with other volunteers/organizers and on the Cooperate WNC website, may we share your contact information? *
Please check off what you can offer:
Are there any supplies or food that you could contribute to a communal pool? Please be specific as you are able.
Your answer
Can you offer housing, short or long term? [there is room to elaborate in following question]
If you can or might be able to offer housing please elaborate on capacity and other relevant info:
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Could you make a financial contribution to individuals in need or to a collective pool?
Do you have access to a vehicle that could be used for rapid response or pre-planned deliveries?
Can you be a Neighborhood Point Person (NPP)? This means you’d take on the responsibility of reaching out to your neighbors, coordinating a neighborhood group chat or phone tree, and staying in touch with the other point people for resource sharing.
What current or potential community centers are close to you? These could include churches, municipal community centers or other city/county facilities, private properties, Cooperative Extension agency facilities, businesses, and so on. If you can, please include a name and brief description of each center, an address or description of location, and a contact person if possible. We are using this information to support neighborhoods and communities in accessing these community center locations for materials distribution and working together to meet other common needs.
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Do you have capacity to help organize our regional mutual aid network? We have a wide range of roles to fill.
Please feel free to express any additional comments, concerns, ideas, exclamations, feelings, anxieties, etc. here:
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