Atlantic County COVID-19 Request Support Form
SLC area COVID-19 "Request Support" Form
If you would like food or other supplies dropped off at your front door, please use this form.

Volunteer with us: https://forms.gle/jaz4ADgNiLkUMJJq5

We are an all-volunteer grassroots group. We are prioritizing folks who are sick, disabled, quarantined without pay, elderly, undocumented, queer, Black, Indigenous, and/or people of color. Thank you for your patience and grace.

Questions, updates or want to get involved?
We are a part of the South Jersey Mutual Aid Hub on Facebook: https://www.facebook.com/groups/915050095585730/
Email: seasonsofgivingnj@gmail.com or nj21united@gmail.com

We are a part of a larger network of mutual aid hubs in NJ. If you are not in Atlantic County, or need someone in need that is located in another county, please reach out to us and we will facilitate connections with the other hub coordinators.

Let's take care of each other. By us for us.

Credit to Seattle Mutual Aid network (@covid19mutualaid on instagram) and Salt Lake City Mutual Aid Network ( @covid19mutualaidslc) for form design and language.
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Name - This does not need to be your legal name. Add your pronouns, too, if you want! *
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How should we contact you? Please include your phone number, email, and/or Facebook messenger -- give several options if possible. *
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Grocery list - Items can be general like "milk," or specific like "a 24-pack of the purple Always brand overnight menstrual pads with wings." We will do our best to match your requests, but if we can't find something specific we may get you a similar substitute. We trust you to know your needs and we are committed to delivery without judgement. Please include quantities.
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Dietary restrictions or allergies? Halal, kosher, vegetarian, vegan, allergic to peanuts, lactose intolerant, gluten-free, scent sensitive, etc -- this is important in case we're trying to substitute "our best guess for what you'd like" in place of "something you asked for" that's out of stock.
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Do you need someone to pick up your prescriptions for you? If yes, which pharmacy? Please either give a phone number/Signal/Facebook messenger option so we can reach you (this option is safer) - OR - include all relevant info here, like your legal name, date of birth, and the names of the medications (Google forms are not secure!).
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Do you need someone to pick up medical or sanitation supplies for you? Please specify which types of supplies you need - masks, hand sanitizer, cleaning supplies etc. These are prioritized for people with disabilities, with suppressed immune systems, and those who are actively sick. We cannot guarantee the availability of these items.
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Delivery Address
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What day do you need things by? Please allow us 48 hours to respond to your request. We can't guarantee timing, but will do our best.
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Any additional specifications, comments, questions, accessibility needs, or drop off instructions?
We will try to let you know if we can meet your request within 48 hours. We're so glad you've reached out to us for support. We want to thank and acknowledge the work of the Seattle Covid 19 Mutual Aid Solidarity Network for their brilliant work modeling for other cities how to create a mutual aid network and for sharing their forms, information, and resources with other groups around the United States and Globally.
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