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CC Mutual Aid Food or Supplies Request Form
*LEA ESTE FORMULARIO EN ESPAÑOL AQUÍ:
https://forms.gle/sDpHyK3E8Zup3dYS9
For financial assistance please complete this form:
--
https://forms.gle/4Bx1e6xgGk2S3pkEA
If you need food or supplies delivered to you, please use this form.
Requests will be filled by volunteers in the order that they are received.
If you cannot fill out the form, do not feel comfortable sharing your personal information, live outside the Corpus Christi area, or need a complete list of resources please contact us:
-- (361) 360-1869
--
corpuschristimutualaid@gmail.com
If you have a time-sensitive food need we recommend that you contact one of your local food pantries, which can be found on this map:
--
https://coastalbendfoodbank.org/get-help/find-food/
*If you do not need support, but want to offer it instead:
https://bit.ly/3dVsequ*
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Email
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Your email
Contact information
Name & pronouns (legal name not required)
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Your answer
Phone
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Your answer
Phone (secondary/backup)
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Your answer
Delivery address
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Your answer
Zipcode
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How should we get a hold of you?
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Email
Phone (text)
Phone (call)
Required
Age
*
Your answer
How many people are in your household?
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Your answer
Details about your request
What kind of support do you need?
*
Food or Groceries
Baby supplies
Other:
Do you have any dietary restrictions, allergies, or intolerances?
Your answer
COVID-19's impact on you and/or your family
Are you eligible to apply for public assistance?
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Did you receive an Economic Impact Payment (stimulus check)?
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Not yet but I do qualify
If you did NOT receive an Economic Impact Payment (stimulus check), do you know why? What disqualified you?
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Are you experiencing any economic disruptions or financial hardship because of COVID-19?
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I was laid off because of COVID-19
My hours were cut because of COVID-19
COVID-19 has not affected me in any way
Other:
Would you like a list of resources to apply for things like unemployment, other financial assistance, etc.?
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I already applied
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