Randolph Area Mutual Aid Need Request
The information provided from this form will be shared with volunteer coordinators and the volunteers in the Randolph, Brookfield, Braintree, and East Granville areas that are needed to fulfill any requests.
This form is for those living in the Randolph, Braintree, and Brookfield areas.

CALL 911 IF YOU ARE FACING AN IMMEDIATE EMERGENCY

CALL 211 IF YOU HAVE IMMEDIATE QUESTIONS OR NEEDS
Email *
Name *
Pronouns
For example: she/her, he/him, they/them, etc.
Phone
If you are unable to answer the phone, do we have your permission to leave a message?
Clear selection
Mailing Address
Physical Address (for deliveries if needed)
Preferred method of contact *
Are you quarantining or self-isolating?
Clear selection
I need...
To ensure that volunteers can help everyone who needs it please mark how urgently you will need assistance. Only check the boxes of what you need.
Low Urgency
Medium Urgency
High Urgency
Delivery of basic needs (food, medication, etc.)
Housing/Heating Assistance
phone check (due to increased stress or thoughts that are impacting how you are feeling)
Transportation
Financial Assistance
Technology Assistance
Childcare, Respite Care
Paperwork assistance (printing, mailing, making copies, etc.)
Mental Health Support
Other
Please explain your needs and how you would like help.
Are there any needs not being met above that you have or foresee yourself having?
This question is for information gathering purposes only. We may not be equipped to handle any needs you list here. Please answer this question so that we are able to see what needs our community has that aren't being met. This way we can work together to build our resources and possibly find a solution.
How did you find out that you could sign up to receive help from this group? *
I understand that this is a network of volunteers trying their best to meet the needs of our community. They may not be equipped to provide exactly what I need but they will help however they can. *
Randolph Area Mutual-Aid Network Organizations:
Bethany Church
Capstone Community Action
Central Vermont Council on Aging
Clare Martin Center
Gifford Health Care
Kimball Public Library
Our Lady of the Angels
Randolph Area Community Development Corps
Randolph Food Shelf
Randolph Rotary
Randolph Select Board
Randolph Senior Center
St. John's Episcopal Church
Town of Randolph
Trivalley Transit (Stagecoach)
A copy of your responses will be emailed to the address you provided.
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