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

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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؟
Are you hard of hearing/deaf and do you need ASL interpretation?
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What is your name? If you wish to remain anonymous, please write "Anonymous" *
How many people are in your household? Please address the following: how many adults, elders, and children? Ages of children.
Do you have special needs?
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.
We will follow up to discuss the details of your request/offer. Who are you comfortable being contacted by? (Check all that apply) *
Phone number *
Email address
What is the best way to reach you? *
In what way(s) can you provide assistance?
In what way(s) are you seeking assistance?
Essential household items (check all below that apply)
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