Care Kit Request
Request to receive [or nominate someone else to receive] a Care Kit that includes a combination of the following: gift card, menstrual supplies, soaps, teas, and other assorted care items. 

Priority will be given to BIPOC Womxn, Sick & Disabled Womxn, and their families, on a first come, first served basis. Care Kits supplies are limited and subject to donations. This means that they may be limited to two per household per year given the high demand.

Care Kits are mailed on a monthly basis, and are based on availability of supplies. If it's been over six weeks since you've sent your request and you have not received your kit, please email brianna@theuprisecollective.org for questions or to find out the status of your order. 

The information you share in this application will only be used to determine recipients of Care Kits - your personal information will never be shared by UPRISE without your consent and does not get reported to any funder or agency. 

This project is funded in part by the Oregon Women's Foundation, Metro, and our membership and individual donors. 
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Who will this Care Kit be for? *
Required
My Name (full first and last name for mailing) *
My Pronouns *
Person I Am Nominating (first and last name for mailing):
Skip this part if you're applying for yourself.
I / They identify as... *
Required
Address *
Where would you like us to send your Care Kit? [UPRISE will never share your information without your consent.]
City, State, Zip *
Email Address *
Phone
Would you like for menstrual supplies to be included in the Care Kit? *
Anything you would like us to know about you / them?
I am interested in learning more about or becoming a  member of The UPRISE Collective. Membership or interest in membership is not required to receive a care kit. *
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