Miner Mutual Aid Intake Census
The Miner Mutual Aid Network unites people and resources to support the Miner community during the COVID19 crisis. Together, we give and receive assistance because no individual or family should be left to fend for themselves.
What is mutual aid?
In systems of mutual aid, communities take on the responsibility of caring for one another. Mutual aid is not charity - mutual aid is solidarity. Mutual Aid is about solving immediate problems together, with a grassroots, community-led approach.
This form is intended to help connect those seeking aid with those able to offer it. Only the members of the Miner Mutual Aid team will see your responses. You do not need to list a specific request, or even give your name in order to use this form. After you fill it out, you will be contacted by the person you select to follow up and discuss details.
DONATE TO OUR MUTUAL AID FUND:
https://www.minerelementary.org/donate.html
* Required
Do you need any translation or interpretation services? ¿Necesita algún servicio de traducción o interpretación? ማንኛውም የትርጉም ወይም የትርጓሜ አገልግሎቶች ይፈልጋሉ? maninyawimi yetirigumi weyimi yetirigwamē āgeligilotochi yifeligalu? Avez-vous besoin de services de traduction ou d'interprétation? هل تحتاج إلى أي خدمات ترجمة أو ترجمة شفوية؟
Your answer
Are you hard of hearing/deaf and do you need ASL interpretation?
Yes
No
Clear selection
What is your name? If you wish to remain anonymous, please write "Anonymous"
*
Your answer
How many people are in your household? Please address the following: how many adults, elders, and children? Ages of children.
Your answer
Do you have special needs?
Dietary restrictions
Chronic illness
Vision/hearing impaired
Other
If you checked any of the boxes above, please let us know if there is information that would be helpful for us to serve your needs.
Your answer
We will follow up to discuss the details of your request/offer. Who are you comfortable being contacted by? (Check all that apply)
*
A member of the Miner Mutual Aid Network (Azeb Kinder, Hannah Williams, LaShawn Oliver, Chris Deutsch)
LaShawn Oliver, Co-chair Miner Equity Team
Monica Woodson, Community Schools Coordinator
Lauren Kraemer or Monica Woodard, Miner social workers
Azeb Kinder, Kindred Organizer/Facilitator
Required
Phone number
*
Your answer
Email address
Your answer
What is the best way to reach you?
*
Email
Phone call
Text
In what way(s) can you provide assistance?
Essential household items
Administrative support: legal support, social services, applying for unemployment benefits
Transportation for community members for essential travel
Housing: a place to stay, tenant's rights, paying rent
Children's needs: school supplies/books, toys, art supplies, outdoor play space
Tech support
Mental health and emotional support: referral to free counseling services; peer-to-peer support through phone calls, video chats, texting
I would like to volunteer at Miner Mutual Aid Network events
I would like to join the Mutual Aid Network team to help coordinate assistance and plan events
In what way(s) are you seeking assistance?
Essential household items (check all below that apply)
Gloves
Hand sanitizer
Masks
Sanitary pads and/or tampons
Toilet paper/tissue
Toiletries
Diapers
Home-cooked meals
Groceries (check all below that apply)
100% juice and packaged fruit
Baby formula
Canned meals
Canned or dried beans
Canned vegetables
Eggs
Hot and cold cereal
Meats and fish
Milk and dairy
Pasta/rice/grains
Potatoes
Snacks
Water
Administrative support: legal support, social services, applying for unemployment benefits
Transportation for myself or family members, or to pick up groceries and other supplies
Housing: a place to stay, tenant's rights, paying rent
Children's needs: school supplies/books, toys, art supplies, outdoor play space
Tech support (check all below that apply):
Getting a device for myself or my child
Learning computer skills
Wifi issues
Mental health and emotional support: referral to free counseling services; peer-to-peer support through phone calls, video chats, texting
Support communicating with my child's teacher/school administration
I prefer not to say. I would like to be contacted to discuss the details of my need.
Help with re-enrolling my child(ren) in school
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