Royalton-Area Assistance Request Form

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This assistance is a Mutual Aid response to the Covid-19 pandemic. We are neighbors sharing resources with other neighbors, and we are not funded or created by any governmental subdivision or agency, though we are working to coordinate with the town-level responses. The person reading your answers is one of four Mutual Aid organizers (this list is otherwise kept confidential) who will then follow up with you to connect you with a volunteer or volunteers able to provide the specific assistance you have requested.

We organize this larger volunteer pool by asking people to fill out the Mutual Aid survey where people list their availability to help each other. You can sign up to volunteer HERE: https://forms.gle/9TxgX2YtcpTX8ZAH8

*Please request assistance at least a day or two in advance of when you need it, if possible.

*If you'd rather speak to someone on the phone than fill out the form, please call the hotline at: (802) 234-1257.‬

*If you are in a high risk situation, you can call the Town Police number (802) 763-7776, option 4, and speak to someone or leave a message. Call 911 with immediate emergencies. You can also dial 211 for more general questions on the Covid-19 pandemic and health concerns. For more information from the town, visit http://royaltonvt.com.

Name *

How can we get in touch with you? Please leave an email address and phone number, if possible. *

What do you need now? Check all that apply. *

Groceries and other household goods

Cloth Masks (Comment on quantity and size below)

Social support and connection (a phone call, a friendly voice!)

Firewood or pellets

Transportation

Technology assistance (internet access, help with email or video-conferencing programs)

Applying for governmental programs (food stamps, disability, unemployment, etc.)

Growing food (advice from local gardeners, a plot at the community garden, etc.)

Other:

Required

If you want, you can list full details of what you need (i.e. a list of groceries, the time and date you'd need transportation, a description of the technical assistance you're looking for) and your preferred way of getting this to you. Otherwise, we can follow up with a call or an email to figure out exactly how to connect you with what you're looking for! *

Do you anticipate needing additional types of support in the future, such as if circumstances change and you have to quarantine for 14 days? If so, please describe. *

Anything else we should know or details about the support you need?

Other thoughts or comments

Submit

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