St. Joseph Community Support
This survey has been created by the St. Joseph Community Support Team of Westphalia to assist our community during this time of need.  There have been a number of people that have volunteered to help other community members in need.  We understand some people are going to be shut-in and may need groceries, hard to find supplies, prescriptions, a meal, transportation, a phone call, a card, financial assistance or simply a prayer.  Please help us help the people in our community that may need support.

Sign in to Google to save your progress. Learn more
Email *
Name *
Phone Number *
Do you, your family or someone in our community need a meal?
Clear selection
Do you, your family or someone in our community need someone to pick up groceries, supplies and/or prescriptions and deliver them?
Clear selection
Do you, your family or someone in our community need transportation?
Clear selection
Are you, your family or someone you know in our community struggling with the quarantine and would enjoy someone calling and talking to them during the day?
Clear selection
Do you, your family or anyone you know need supplies,  but are unable to find them in the store?  If so, please list those items.
Do you know someone that could use an uplifting card to brighten the days in quarantine?
Clear selection
Do you or someone you know need financial assistance in this time of need?
Clear selection
If you have other needs, please describe them below:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy