Standish-Ericsson COVID-19 Neighbor Assistance Request Form

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This is an effort to provide assistance with errands or other needs for sick, elderly, immunocompromised, or otherwise vulnerable neighbors in the midst of the COVID-19 situation. If you or someone you know have such needs, please complete the form. If you're unsure whether your needs qualify, please just go ahead and complete the form and we'll contact you to discuss!

Esto es una esfuerza para conectar gente con necesidades con gente que puede ayudar. Para comunicar sus necesidades durante este situacion dificil de COVID-19, por favor llame a (612) 721-1601. Gracias!

Full Name *

Phone Number *

Email *

Address *

What needs do you have (e.g., food items, assistance with errands, etc.)? *

Do you need items delivered? *

Yes

When do you need this assistance? Please note date/time

Is there anything else we should know about your needs?

I give my permission to share the information on this form with the volunteer(s) who will be assisting me *

Agree

Submit

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