Faith in Humanity Mutual Aid Request Form
Please fill out the following intake form and we will find a volunteer to help fulfill your request
Your name (First and last name, or last initial)
Street Address, City and Zip Code
Your phone number
Which way do you prefer to be contacted?
This request is for
Someone else (please add their name and address in the next section)
Address (street address and city) where to send/deliver, if different from the one above.
If the request is not for yourself, please provide the name and/or organization in need
How soon do you need this? (We will do our best, but make no guarantees)
Soon - by end of next day
Soonish - next 3 - 5 days
Not urgent - within the next week
What can we help with? (Please select the options which apply and if other please specify in the request details
Medical Supplies / Pharmacy
Pet care/dog walking
Misc. shopping or Pick Up
In home assistance with personal care
Financial assistance (up to $50)
Emotional support over phone/video
Personal Protective Equipment (PPE) Please describe what you need in List request details below.
Help getting/strengthening internet/wi-fi
If you need any assistance within your home or need to list any other tasks we didn't have above, please describe the tasks so we can let the volunteers know?
List request details (Please give as much detail as you can while also understanding choices might be limited. For example, for groceries, please indicate any preferred size, brand, flavor, etc. - Dawn Ultra dish soap 16.2oz bottle - and our volunteer(s) will do their best). If you need gloves, name the brand, sterile vs. non sterile, size, etc. Please let us know if substitutes are NOT acceptable
Delivery instructions (All pick-ups and deliveries will be contactless, but please indicate if items should be picked up / delivered in lobby, in front of apartment door, with a doorman, etc. Provide any details might be useful for our volunteers)
Any other details we should know about?
Thank you for being part of this Mutual Aid Group!
We know it is not easy to ask for help. This is not charity. The donors and volunteers have asked to help and want to give back. This is a group where both sides should feel good about giving help and receiving help. It shows compassion for ALL of us and gives us "Faith in Humanity". In gratitude.
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