Mask Request Form
Arkansas Arts & Fashion Forum is a Northwest Arkansas-based non-profit whose mission is to provide educational and professional opportunities for Arkansas-based creatives.

We have activated an extensive network of volunteers to help produce masks for our frontline public servants. We want to provide as many masks as we can, and will continue taking orders as long as the crisis continues, or until we have exhausted our supplies and volunteers.

If you are a hospital, medical clinic, nursing home, police station, fire station, delivery driver, grocery store worker, or other public facing employee please feel free to request masks. We will be assigning masks preferentially to health care professionals but will continue to collect masks for our public servants. All masks are donated. In order to continue our project we are soliciting donations to help pay for staff managing this project. If you are able to contribute, please consider visiting our secure donation website to support our mission: https://secure.qgiv.com/for/masmakcha/

If you have any questions about the masks please visit our website at arkansasfashion.org/masks or email rachel@arkansasfashion.org.
Sign in to Google to save your progress. Learn more
Email *
Contact Name *
Contact Phone Number *
Organization Name / Clinic Name (if applicable)
Which type(s) of masks do you need? *
Required
If you marked other, please describe or send a picture to rachel@arkansasfashion.org
What is your estimated number of masks that you will need? *
How can we get the masks to you? *
If you need masks delivered to you, please provide your address. Masks can only be delivered within the Northwest Arkansas region. If masks are being requested outside NWA, we ask that you please cover shipping costs.
Thank you so much for your service to our community. If you can, please consider donating to our program to help cover the administrative and material costs of this project.
You can visit our secure donation site at https://secure.qgiv.com/for/masmakcha/
DISCLAIMER:
*note: these masks are not approved for use as anti-viral personal protective equipment, but rather falls into the category of homemade masks that are described by the CDC as suitable for use during severe resource limitations. From the CDC:

“HCP use of homemade masks: In settings where face masks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.”
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Arkansas Fashion Week. Report Abuse
Google Forms