Villa Exchange Request Form
Welcome to our Village! We are happy to get you and your family the help you need. Please submit your request below.
If you are in an urgent situation, then please email us directly at VillaAdvocacy@gmail.com so we can connect you with the proper resources. #ItTakesAVilla
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Email *
What’s your first name? *
What’s your last name? *
Are you part of our Villa Exchange Facebook Group? If not, please join now so that we can connect with you to coordinate your requests: https://www.facebook.com/groups/740922973731299/?ref=share *
Are you part of our main Villa Facebook Group? If not, please join now: https://www.facebook.com/groups/540624377325999/?ref=share *
What’s your Facebook name? (If no FB write N/A) *
What’s your phone number? *
If you are in an urgent or unsafe situation, please indicate a safe way/time to contact you along with any other details you wish to share.
Can you receive texts? *
What is your street address? *
Apt or Unit # (if applicable)
City *
State *
Zip Code *
What are you requesting help with? (Check all that apply) *
Required
If requesting Formula, what date do you expect to run out by?
MM
/
DD
/
YYYY
Please describe the items you need. Be as specific as possible (babies gender, brand, preferences, allergies, any other relevant info.) **If requesting Formula, please specify powder or liquid/RTF and list if your baby can take any alternate types** *
What size/sizes? (If applicable)
Are you able to cover the shipping cost? (If applicable) - **At this time, we are unable to cover shipping so we will have to wait until you find a sponsor to cover shipping. You may ask for one on the Villa Exchange or Villa Facebook Group** *
How are you connected to motherhood (Are you a mom, caregiver, etc.)? Feel free to tell us about your family and kids ages or anything else you’d like us to know about your situation. *
What is your child(ren)’s name? *
What is your child(ren)’s age? *
What is your child(ren)’s gender, if you’d like to share?
How did you hear about Villa/Villa Exchange? *
A copy of your responses will be emailed to the address you provided.
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