43rd District Resource Provider Sign-Up Form
Senator Mary Washington has been working in Annapolis with colleagues to pass emergency funding for COVID-19 resources while simultaneously coordinating with people on the ground in the 43rd District to convene a 43rd District Resource Assistance Team with the Baltimore City Delegation. This team is meant to pull together and streamline critical resources to keep you informed, as well as act as a volunteer delivery service for those who may not be able to leave their homes due to being at-risk. Delivery includes only picking up (not ordering) medication, household groceries, food, and any other needs you may have.

The purpose of this form is to collect information about what services/resources individuals and organizations within the 43rd District are offering to provide for those in the community that do not have the ability to leave their home. Please leave a detailed response in the applicable description box.

After you fill out this Resource Sign-Up form, we will contact you to go over details and availability. For any further clarification please contact us at 43rddistrictrt@gmail.com

DISCLAIMER: This resource is not for medical advice, but to connect you and loved ones to necessities as well as provide updated information whenever possible. If you, need to speak with a medical professional, call your primary care doctor or 2-1-1. If you can't reach 2-1-1, call (410) 685-0525 for the Greater Baltimore Area. You can also visit health.baltimorecity.gov for updates from the Health Department.
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I am a/an
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First Name *
Last Name *
Organization (optional)
What age group do you fall in?
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What hours are you available
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Organization Hours
Zeit
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Full Street Address *
Neighborhood *
Phone Number *
Email *
Best contact method: *
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What resources or services are you offering: *
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Any other services/resources you can offer (please detail):
Anything else we should know:
Please read the following document before checking the box below - https://drive.google.com/file/d/1QKXCYh5jv0eFN1iLgB6Cixp_cTOWwCbr/view?usp=sharing *
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