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HRG Intake Form
If you're unable to do the tasks listed below (e.g. not living in/near Philly) but are able to access individuals from your network who can please continue to fill out the form.
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Email
*
Your email
Name/Pronouns
*
Your answer
Phone
Your answer
Are you able to assist with tasks such as moving heavy boxes and furniture?
Yes
No
Clear selection
Are you able to provide home cleaning tasks? (laundry, dishes, organization, etc.)
Yes
No
Clear selection
Are you able to provide general home maintenance tasks? (painting, yardwork, etc.)
Yes
No
Clear selection
Do you work in field that provides you with any special skills or gives you access to helpful resources? Please describe.
Your answer
Are you currently involved in a pod to pool and redistribute funds to HRG?
Yes
No
No, please contact me about joining or creating one
Clear selection
Do you have a car? If so, what size?
Your answer
Are you able to provide scheduled rides?
Yes
No
Clear selection
Are you able to lend your car?
Yes
No
Clear selection
Describe any other skills that you can offer as a form of redistributed labor.
Your answer
Are you able to activate your personal network to provide any of these tasks?
Yes
No
Clear selection
Describe your interest in doing work with the Housing Reparations Group. The HRG centers Black Queer, Trans, Darker Skin, Fatter, Disabled, Hood, Femmes, therefore, anti-blackness, homophobia, transphobia, colorism, ableism, fatphobia, classist, misogynist sentiments will not be tolerated and actively held to account. How will you dedicate yourself to this mission? Please review these resources and reflect on them in your response: Reparations Now Toolkit:
https://m4bl.org/wp-content/uploads/2020/05/Reparations-Now-Toolkit-FINAL.pdf
Simmons Resources:
https://simmons.libguides.com/anti-oppression
Your answer
If you have any additional comments or information please share below:)
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