Queens NY COVID-19 "Volunteer" Form

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We are an all-volunteer grassroots group operating in the various neighborhoods of Queens. We want to help folks who are sick, disabled, quarantined without pay, elderly, undocumented, immigrant, queer, Black, Latinx, Indigenous, -- including those displaced in nearby areas like Long Island.

Please fill out this form if you would like to help us coordinate food and supply drop-offs to people's front doors. Please use this form if you would like to help make deliveries. Thank you!

If you can't deliver things but would like to help people fill out forms for government assistance, financial grants, fill out this form.

If you can provide legal support, fill out this form! Thank you.

If you're looking for help please email qnsmutualaid@gmail.com or fill out this form with your info.

This list will only be shared with others doing mutual aid work and folks who need mutual aid. We won't use or share your info for any other purpose.

Stay strong and be safe! We are doing our best to respond to new developments as quickly as we can. Please bare with us.

Name *

This does not need to be your legal name.

Pronoun

How do we get in touch with you? *

Please give several options if possible.

call

text

Other:

Required

Cell Phone Number *

What is your email address? *

Do you have access to a vehicle?

Yes

Other:

Clear selection

Do you need money for transportaion?

We want to ensure that those who want to provide mutual aid do not face undue burden.

Yes. I would like to be reimbursed for gas/bus or train fare.

Other:

Clear selection

Would you like to help pay for groceries/supplies?

We want to ensure that those who want to provide mutual aid do not face undue burden and we absolutely do not expect you to spend money if you are financially limited.

No. I will need money ahead of time in order to buy the groceries.

No. I have the money to make the initial purchase, but I will need reimbursement.

Yes. I will donate any groceries I pick up.

Depending on the items I might be able to donate any groceries I pick up.

Other:

Clear selection

What type(s) of money transfer work for you?

Cash

Check

Venmo

Paypal

Other

Are you comfortable picking up prescriptions?

We will help coordinate any paperwork needed and pharmacy location.

Yes

Other:

Clear selection

Are you 21+ with a valid ID?

Yes

Other:

Clear selection

What's your address? *

Doesn't need to be your actual home address, could just be an address nearby. This is only for the purpose of matching you with someone closest to your neighborhood. Please include zipcode.

What neighborhoods would you prefer to deliver to?

List as many as you can.

Are you able to make a financial donation to someone in need?

$50

$100

$200

$300

$400

Can you help people fill out forms for government assistance and unemployment?

Yes

Clear selection

Can you provide legal support?

Yes

Clear selection

What languages do you speak? Are you able to help us translate writing? Could you interpret a conversation in person or by phone? *

We are using WhatsApp to form local neighborhood groups, are you willing to learn how to use it and would you be interested in forming one for your block or neighborhood?

Yes

Other:

Clear selection

Any additional specifications, comments, or questions?

Clear form

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