COVID-19 Needs Request Form
Full Name *
Gender (this will help us assign volunteers to provide assistance) *
Address *
Phone *
High Risk: Are you considered high risk for serious illness for COVID-19 because of your age or because you have a serious long-term health problem? *
Please describe how we can help. Our goal is to reach out to you within 24 hours to discuss how we can help you during this time. MacArthur Blvd will not be able to meet financial assistance needs, but we will try to meet as many needs as possible. *
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