NEED ASSISTANCE FORM

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This is an attempt to figure out who in our community may need NON-EMERGENCY assistance while we fight COVID-19 (aka the novel coronavirus). The hope is that we match volunteers with requests in Oxford OH. Please be advised that, for now, this service is only available through the month of December 2020.

These efforts are through a partnership between the City of Oxford, Oxford Bible Fellowship, and the Department of Geography at Miami University. Only Amelie Davis with Miami University and staff at Oxford Bible Fellowship have access to your full responses. We will then try to match you with volunteers based on the task needed. The questions with the red asterisks are the only required questions.

If you prefer to register to volunteer or ask for assistance on the phone, please call (513) 523-5300 anytime Monday through Thursday from 9AM to 3PM. We are also available via email at info@obf.org.

For emergencies please dial 9-1-1.

What type of assistance do you need? *

Please select as many choices as apply.

Medicine delivered (paid by requester)

Groceries delivered (paid by requester)

Free food donations

Someone to talk to (on the phone or via Facetime for example)

Someone to stop by and wave through window

I am a student and need a temporary (quiet) location to study

Other:

Required

Please let us know why the help is needed. *

I am over 80 years old.

I am over 60 years old.

I am considered an at risk person due to underlying health conditions (pregnancy, asthma, etc.)

I have been ordered to quarantine myself

I am in self-quarantine due to possible exposure

I have no transportation

I am worried about leaving the house

I am socially isolated

I/we no longer have sufficient income

I am homeless (or the person I am filling out this form for is homeless)

Other:

Required

How many adults (individuals over 18 years of age) live in your household

How many children live in your household

What was your net income last month in U.S. Dollars. Depending on your income you may qualify for further assistance.

This question is optional.

Please provide a more detailed description of what you need.

Please remember that this service is for NON-EMERGENCIES ONLY.

My first name is *

My last name is *

What is your email address if you have one?

What is the best phone number to reach you please?

Please use this format XXX-XXX-XXXX.

Can you receive text messages at this number?

Yes

Yes, but only individual text messages (NOT group text messages)

Other:

Clear selection

Do you prefer to be reached by email or text message?

Text message

Any of the above

Clear selection

What mode(s) of communication are you comfortable with (and are available to you at the moment)? *

Text message

Facetime

Google Meet (formerly known as Hangouts)

Phone call

Other:

Required

What mode of communication is preferred? *

Text message

Facetime

Google Meet (formerly known as Hangouts)

Phone call

Any of the above

Other:

What is your address? *

If you are homeless please indicate where we might find you.

If applicable, what is your apartment number?

What is your zip code? *

By when do you need what you asked for? *

Please give the latest absolute date by which you feel you need your request filled. If it is not urgent please put a default date of December 31st 2020. Lastly, please remember that we are ENTIRELY DEPENDENT ON VOLUNTEERS and that if we have few volunteers we MAY NOT BE ABLE TO GET TO ALL OUR REQUESTS. We will however send group emails and group text messages about the status of our volunteer network and the volume of requests we are receiving.

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