Neighbors helping Neighbors: Request For Aid - Philly Mutual Aid for Folks affected by COVID-19
Though COVID-19 is only just beginning to impact our city many of our neighbors have already been affected. This means we need to show up for each other. Especially for those who are at great risk.

If you would like food or other supplies dropped off at your door, need prescriptions picked up, transportation assistance please use this form.

We are prioritizing those most vulnerable and affected by COVID-19 : the sick, disabled, quarantined without pay, those limited in work, undocumented, queer, Black, Indigenous, and or people of color.

Philly mutual aid update!
First over 100 people have filled out the form offering services and support! Keep sharing, sharing.

Second, here is a form for folks who need to request services.
http://bit.ly/phillymutualaidcovid19request

How this works: When a request for aid is made we will go into our network of community members who have offered services ranging from delivering groceries/medicine, providing transportation assistance, donating money etc and we match the person who made the request with the people/people who can provide support.

The important disclaimer: We are simply neighbors helping neighbors. The aid provided comes from community support and solidarity thus we cannot guarantee to meet each request but we will be trying our best to do so . We are not funded, we are not a government or medical agency, we are simply neighbors connecting neighbors to neighbors who can help (and we happen to be organizers

We know that some of the most affected and most high risk people may not have access to the internet so please make sure to these point resources to those folks. We're depending on people to be good faith actors. Don't request help if you don't need it. Please, we are trying to help those who need it.

If you would like to become a part of the support network and provide support services to those affected by COVID-19 fill out this form http://bit.ly/phillymutualaidcovid19 and we will connect you with some one in need of assistance.

Thank you to the rad folks at the Seattle area Mutual Aid Solidarity Network for making the request form inwhich this form was modeled after.

*This form was created by Tamara Baldwin on March 12, 2020
Managed by Tamara Baldwin (tblj1234@gmail.com), Rianna Salm (mlsnnr3@gmail.com) and Tab (tabsk@protonmail.com)

Name? *
*This does not need to be your legal name. Feel free to share your pronouns*
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Your answer
Where are you located? *
How Should We Contact You? *
*Please include phone, signal, email and/or facebook messenger*
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Your answer
Has the COVID-19 (Corona virus) virus has affected you (directly or indirectly)? If yes, how?
Your answer
Can you share some ways you identify yourself? i.e class, race, gender identity, (dis)ability etc
Your answer
Do you need Groceries picked up and delivered to your door? If yes, do you need assistance paying for your groceries? How much?
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Your answer
How Many People Are In Your Household?
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Your answer
Dietary Restrictions
Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock.
Your answer
What Types of Foods Do You Want?
Grocery List *Items can be general like milk" or specific like a "24 - pack of Always brand overnight menstrual pads with wings". Delivery without judgement* *
Your answer
Do You Need Someone to Pick Up Your Prescriptions for you? If yes what pharmacy and do you need assistance with paying?
*Please either give a phone number/Signal/Facebook messenger option so we can reach you (this option is safer) - OR - include all relevant info here, like your legal name, date of birth, and the names of the medications (Google forms are not secure!).*
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Your answer
Do you need financial assistance? If so, how much
We do not have a fund
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Your answer
Do you have any other needs or requests?
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Your answer
Delivery Address?
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Your answer
What Day and Time do you need things buy?
We can't guarantee timing but will encourage folks to do their best
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Date
Time
:
Any additional specifications, comments, questions, accessibility needs, or drop off instructions?
I.e contactless delivery, meeting at pick up spot etc
Your answer
We will try to let you know if we can meet your request within 48 hours.
We will try to let you know if we can meet your request within 48 hours. This form was modeled after the resource form created by rad folks at Mutual Aid Solidarity Network. " Drawing from the brilliance, love and creativity we have for each other and looking to learn from those showing solidarity globally, including those in Wuhan, China, we aim to cultivate a politics of autonomy, solidarity, and mutual aid within a long-term, multi-generational horizon of decolonial, anti-capitalist, feminist, queer, and disability liberation. Close all prisons, juvies and detention centers now! " Solidarity.
Your answer
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