Portland-area COVID-19 "Offer Support" Volunteer Form
Please use this form if you would like to help make deliveries, or offer support.

We are prioritizing assistance to folks who are sick, unhoused, disabled, quarantined without pay, elderly, undocumented, refugees and immigrants, Black, Indigenous, People of Color, trans, and/or queer, including those displaced from Portland to the nearby areas. Thank you for your patience and grace.

We are an all-volunteer grassroots group operating in the territories of the many tribes who have made their homes near the confluence of the Willamette and Columbia Rivers, including Multnomah, Wasco, Cowlitz, Kathlamet, Clackamas, Bands of Chinook, Tualatin, Kalapuya, Molalla.

Questions, comments, and updates can be found at:
Facebook: https://www.facebook.com/pdxcovid19mutualaid
Instagram: @pdxcovid19mutualaid
Email: pdxcovid19mutualaid@gmail.com

To make a contribution and read about our efforts in more detail, please visit: https://www.gofundme.com/f/pdx-covid19-mutual-aid-network-fundraiser

If you're looking to Request Support, that form is found at this link: https://forms.gle/ScrRG5jEbqMGdibB6

Let’s take care of each other. By us for us.
እርስ በርሳችን እንከባከብ። በኛ ለኛ።
Vamos a cuidarnos unes a otres. Por nosotres, para nosotres.
守望相助。
Name *
This does not need to be your legal name. Add your pronouns, too, if you want!
[Image is a red name tag that says "Hello my name is" with nothing written in the blank space.]
[Image is a red name tag that says "Hello my name is" with nothing written in the blank space.]
How should we contact you? *
Please include your phone number, email, and/or Facebook messenger -- you can give several options if you'd like.
[Image is a sketch of a smartphone open to a home page with many apps.]
[Image is a sketch of a smartphone open to a home page with many apps.]
Do you have access to a vehicle? *
[Image is a side view of a small green car with a shadow beneath it.]
[Image is a side view of a small green car with a shadow beneath it.]
If you do not have access to a vehicle, how far are you willing to walk from bus lines? Carrying how much weight?
Feel free to include notes like "I use a bike" or "I want to buddy up with someone who has a car."
[Image is of a person with long brown hair, light skin, flip flops, a blue shirt, and a black skirt carrying two boxes. The boxes look like they might fall and the person is nervously sticking their tongue out.]
[Image is of a person with long brown hair, light skin, flip flops, a blue shirt, and a black skirt carrying two boxes. The boxes look like they might fall and the person is nervously sticking their tongue out.]
Do you need to be paid for your transportation or time? *
We want to ensure that those who want to provide mutual aid do not face undue burden.
Would you like to help pay for the groceries / supplies?
Again, we want to ensure that those who want to provide mutual aid do not face undue burden and we absolutely do not expect you to spend money if you are financially limited.
Clear selection
What type(s) of money transfer work for you?
[Image is a drawing of a light skinned hand grabbing three green $ bills. The background is a yellow square.]
[Image is a drawing of a light skinned hand grabbing three green $ bills. The background is a yellow square.]
Are you comfortable picking up prescriptions? *
We will help coordinate any paperwork needed and pharmacy location.
[Image is an orange pill bottle with a white lid and a sticker that says "Rx" in blue, illustrated to look as if there are more lines of text. The background is a teal circle.]
[Image is an orange pill bottle with a white lid and a sticker that says "Rx" in blue, illustrated to look as if there are more lines of text. The background is a teal circle.]
Are you 21+ with a valid ID? *
[Image is a drawing of a light skinned hand with red fingernails holding a blue and white card. The card says "driver license" at the top, has a head shot of a person with short brown hair on the left, and lines made to look like text on the right.]
[Image is a drawing of a light skinned hand with red fingernails holding a blue and white card. The card says "driver license" at the top, has a head shot of a person with short brown hair on the left, and lines made to look like text on the right.]
Do you agree to trust that each person making a request knows their own needs? Can you agree to make deliveries without judgement? *
(We will not ask anyone to buy or deliver anything illegal.) If your answer is "Yes, except..." please select Other and list the specific supplies or groceries you are uncomfortable buying / delivering.
What neighborhoods would you prefer to DELIVER to?
[Image is map of Portland neighborhoods]
[Image is map of Portland neighborhoods]
Generally, what times are you available?
You may also leave more specific day and time schedules in the "Other" write in box.
What languages do you speak? Are you able to help us translate writing? Could you interpret a conversation in person or by phone? *
This includes spoken and/or sign languages.
[Image is a collection of multi-colored speech bubbles that say "Hello!" in many languages.]
[Image is a collection of multi-colored speech bubbles that say "Hello!" in many languages.]
Do you have any accessibility needs you want to share, or need anything else to feel safe providing deliveries?
Do you have other skills you would be willing to provide?
In the near future, we are considering expanding the types of mutual aid we offer. These might include transportation, emotional support, household assistance, childcare, dog walking, petsitting, etc. Please note access details when possible, like: are you able to be scent-free (http://thinkbeforeyoustink.com/howtogofragrancefree.html)? Do you have a wheelchair accessible van?
Any additional specifications, comments, or questions?
Are you interested in joining the coordinating team for this project?
Clear selection
Thank you again for taking time to fill out a support form! We will try to contact you within a week.

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!
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