What do you need?

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What do you need?

During a public health emergency, many people in our community may require extra help from their neighbors. This includes the elderly or immunocompromised, (those who have the most need to practice social distancing at this time), or those that have been quarantined.

This is a public form managed by a team of local volunteers. We will do our best to connect you to organizations and community members that can help you. This form is for specifically for folks in Palouse the town, 99161, but if we can connect you to other resources we will do our best.

Name (as on Facebook or Social Media) *

Phone number

I prefer to be contacted by: *

Facebook

Phone

Other:

Required

Address *

Zip Code *

Risk Assessment (check any that apply)

60+ years old

Working Family

Health Conditions

Other:

What kind of support are you in need of?

Childcare

Groceries

Supplies

Financial

Mental Health / Emotional

Spiritual (we can put you in contact with local church leaders)

Social (someone to communicate with)

Other:

Is there other information that would be helpful for us to know? Are there other ways you need support that aren't listed above?

Submit

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