North NJ COVID-19 Mutual Aid Form
Please fill out this form to the best of your ability. If you are in the North New Jersey area, join this Facebook group in order to be post about and be connected to ongoing efforts/resources
https://www.facebook.com/groups/349149839305990/

*IF YOU ARE IN A RISK CATEGORY, PLEASE KEEP YOUR OWN SAFETY IN MIND IF OFFERING HELP*
Email address *
Name *
Phone Number *
Age
Location
Please share your city/town and your neighborhood/area, not your specific address
Are you offering a resource (housing, food, transportation, etc.) or requesting a need (place to stay, ride to an appointment, etc.)? *
If requesting a need, what are you requesting?
If offering a resource, what can you offer?
Details *
Are you in a risk category (immunocompromised, chronic condition including asthma, hypertension, diabetes, etc)? *
Do any of the following apply to you? *
Please answer honestly. We will not ignore you based on your response to this. We just need to know so we can act accordingly.
Required
If you are in the North New Jersey area, join this Facebook group in order to be post about and be connected to ongoing efforts/resources https://www.facebook.com/groups/349149839305990/
Help us organize! We need people to help connect resources with those in need--you don't have to live in the area to help! *
Anything else? *
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