"Nourishing the Community": A Partnership with The Center & Urban MO's - Jan 2021
The San Diego LGBT Community Center, in partnership with Urban MO's Bar & Grill, will be providing meals for community members who have been impacted by COVID-19. Please fill out the information below and you will be emailed a community meal certificate within 48 hours. The email will provide you with detailed information about the program and the certificate can be used to pick-up your meal at the restaurant. The certificate will only be valid between January 8-31, 2021. This survey form must be filled out for every community member (10+ years old) who is requesting a warm meal. For any additional questions, please email Sarah Merk-Benitez at smerkbenitez@thecentersd.org.
Email address *
Name (Legal or Chosen)
Pronouns
Date of Birth *
MM
/
DD
/
YYYY
Address
Zip Code *
Phone Number
If applicable, how many individuals in your household are 9 years old or younger and requesting a kids meal? (Please remember, all individuals 10+ years old requesting a meal must complete this form.)
My race/ethnicity is (choose all that apply):
My gender identity is (choose all that apply):
Do you consider yourself part of the LGBTQ community?
Clear selection
Do you consider yourself part of the Transgender community?
Clear selection
How have you (and your household) been impacted by the COVID-19 pandemic? (examples: Loss of job, Loss of hours, Older Adult/Senior, Immuno-compromised, caring for a family member, etc.) *
Submit
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