Autoimmune-Compromised and Disabled Rural Queer Mutual Aid
This is a form by Queer Appalachia to organize mutual aid to autoimmune compromised and disabled rural queers. You can use this form to sign up to receive outbreak supplies or send out some supplies.

We @ QA know first hand that if you present outside the gender binary, its likely you have a hard time accessing health care with dignity. As more complications enter- like autoimmune issues, disability- it's becoming dangerous to even go outside. Our health care system is not prepared for the surge of Covid-19 patients about to need care and the federal government is failing us. Queers who present outside the gender binary are likely to not be safe or cared for with compassion at a rural hospital. We think it's best to hunker down and avoid it if at all possible. The people who are most vulnerable to this disease are not always in a position to stock up right away.

If you need cleaning supplies, use this form and tell us what would be most helpful to you.

If you can send supplies, use this form to sign up. We can set you up to assist 1-3 people depending on your ability. We want to be very mindful of pulling too many supplies from one area.
Can you shop but need help paying? Let us know!

We are opting to arrange direct mailing to streamline this process and keep potential exposure down. QA has taken steps to drastically limit our time outside in order to protect the vulnerable among us.

You can also help by sending some $$! Venmo: Queer-Appalachia PayPal: Queerappalachia@gmail.com

Instructions for form:
Section 1 is for basic contact info
Section 2 is for queers in need (leave blank if you are signing up to send supplies)
Section 3 is for queers who can send supplies (leave blank if you are in need)
Sign in to Google to save your progress. Learn more
Email *
Section 1: Contact info for everyone to fill out
Your name
Where you are based (city, state). We want to be mindful of shipping distances and attempt to keep shipping costs down.
Section 2: For autoimmune-compromised/ disabled rural queers in need of supplies
leave blank if that doesn't apply to you
What would be the most helpful to you? Are you looking for cleaning supplies, soap, over the counter medicine?
Whats the address to send these to?
Section 3: For queers who can pick up supplies and send them to someone in need
leave this section blank if it doesn't apply to you
Give us an idea of your approximate budget.
How many packages are you willing to send out? It's ok to under-estimate yourself and resubmit this form if you wanna take more on in a week or two.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy