Request Form: Cleveland Pandemic Response
Need help with this form? TEXT 216-200-6833 
¿Necesita ayuda con este formulario? Envíenos un mensaje de texto a 216-200-6833 




HOW DOES THIS WORK?

We usually organize weekly deliveries, but we fulfill requests as our individual and collective capacity allows. We can usually deliver to people in Cuyahoga County.

One way we protect our capacity is to only communicate using text messages to coordinate deliveries. We usually will not listen to voicemails.  

Here is our process:
  1. You fill out this form
  2. When you submit the form, you will get a confirmation email from forms-receipts-noreply@google.com
  3. We text you from ‪(216) 200-6833 in about a week (please add this number to your mobile contacts). We can only deliver if you text us back because we need to confirm with you
  4. On the day of your delivery: the delivery driver will text you. After you respond to your delivery driver’s text, then they will drop off your items.
We can only deliver if you respond to text messages from ‪(216) 200-6833 AND texts from your delivery driver.




HOW OFTEN DOES CPR DELIVER? WHAT DO YOU DELIVER?

We do NOT limit requests, and you can submit a new request at anytime. HOWEVER, we only have capacity to deliver to the same person/address EVERY 8 WEEKS

We cannot guarantee that we will be able to fulfill all of your requests. We can only share what we have available




WHO IS CPR?

Cleveland Pandemic Response (CPR) is a mutual aid network created to do what we can for the material needs of our neighbors and each other during the Covid-19 pandemic. CPR is not a non-profit; we are not professionals, we do not have grant or other funding, and we are not getting paid. All the items we distribute are purchased with crowdfunded dollars, or sourced through groups and individuals we are in relationship with. 

When you text CPR, you are communicating with fellow community members who are working out of our homes in our spare time because we believe in mutual aid, community care, and liberation for all.

If you are being referred to CPR by a caseworker, non-profit, or government program, please understand that they have resources CPR does not. It is WILD that organizations with annual budgets and HR departments and offices are sending folks to a little mutual aid group delivering toilet paper out of someone's garage.

Mutual aid is NOT charity. Video: What is Mutual Aid? Dean Spade (7:37 min)




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You can find a list of community resources at our webpage


      

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Email *
What language are you most comfortable using? 

We will communicate with you using text messages
Have you ever asked us for anything before?
*
Required
Your Name

(You can use your first name or chosen name)
*
Your cell phone number
*
Address where we can deliver things to you *
Your Zip Code
How many people live in your household?

(If we can, we try to share more things with larger households)
*
Do you need toiletries? (supplies are limited)
*
Required
Do you need cleaning products? (supplies are limited)
*
Required
Do you need menstrual products?  (supplies are limited)
Clear selection
Do you need a reusable menstrual cup? (supplies are limited)

(Click Here to see what size you need.)
Clear selection
Do you need incontinence supplies(supplies are limited)

Clear selection
Do you need condoms?

(supplies are limited)
Do you need safer drug use supplies? (supplies are limited)

- Narcan Nasal Spray: a medicine for emergency treatment of a known or suspected opioid overdose
-Fentanyl test strips: to test drugs for Fentanyl, a deadly chemical that is added to many drugs
Do you need Plan B, the "morning after pill"? (supplies are limited)

We offer Plan B so you have it if you need it in the future.
*
Do you need pregnancy and/or ovulation tests? (supplies are limited) *
Required
Do you need diapers? (supplies are limited)

Tell us:
-what size(s) you need?
-how many children need each size?

For example, "size 2 diapers for one baby, size 5 diapers for twins, 3T/4T pullups for one child"
Would you like rice, dried beans, and taco seasoning? (supplies are limited)

(Do we think you only deserve rice and beans? Absolutely not. Everyone deserves the food they want, without proof of need. These limited items are just what our little collective can offer.)

For info on food assistance, you can visit:

Clear selection
Do you want masks for CHILDREN? (supplies are limited)

KN95 masks
- Provide excellent protection against Covid-19.
- CAN BE REUSED
- we include instructions and supplies to safely reuse these masks
How many ADULTS in your household need masks?

KN95 or LL95 masks
- Provide excellent protection against Covid-19.
- CAN BE REUSED
- We include instructions and supplies to safely reuse these masks
Clear selection
Do you need Covid rapid tests? (supplies are limited)

(note: rapid tests are best used to confirm Covid if you have symptoms. False negatives are common - you may  still have Covid even if you have a negative Rapid Test).
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What Cleveland neighborhood OR city do you live in?

(exp: Clark-Fulton, Slavic Village, Mt Pleasant OR Lakewood, Parma, South Euclid)
What part of the Greater Cleveland Area do you live in?

(This helps us coordinate delivery drivers)
Clear selection
Do you have other needs? Sometimes we can reach out to our networks and suggest other ways to get assistance.
How did you hear about CPR?
If CPR has delivered to you before, you may have some items you didn't end up using. Please share them with your family, friends, and neighbors!

If you have unopened products that you want to return for us to give to others let us know!
A copy of your responses will be emailed to the address you provided.
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