Anjuman e Asghari & IHIC Community Assistance Form

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With the spread and fear of the coronavirus, we are strongly encouraging folks to stay home, especially if you are sick, over the age of 60, or are at risk of getting sick.

During this time, if you are in need of any help or assistance like picking up groceries, prescriptions, or any other local errand, please reach out to us. We have a team of brothers and sisters on standby to help with the community needs.

Please fill out this form and our team of volunteers will get back to you as soon as possible.

Email *

Name *

Address

Phone Number *

What type of assistance do you need? *

Grocery Shopping

Transport (Clinic or Hospital Visits)

Medication Pick-up & Drop-off

Preparing & Delivery of Meals

Other:

Required

When do you need this done? *

YYYY

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