Needs Survey

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Needs Survey

Please fill out this form to assist us in best matching services and resources to needs. If you have the ability to order supplies online, please so do and utilize this form for other needs.

If you are aware of any EGR residents who are unable to fill out this form independently, please assist them in doing so or encourage them to contact our Volunteer Coordinator, at eastgrcoordinator@eastgr.org or 616.425.9402.
Please note that a request is not a guarantee of service, and we will do our best to match volunteers to residents in a timely manner.
Please contact us for further information or questions.

Be sure to select "submit" at the end to ensure your responses are recorded.

First and Last Name *

Email address

Phone Number *

Best method of contact *

Phone

Home Address *

May we share pertinent information (phone, email, address, etc.) with your volunteer match? *

Yes

Are you currently self-quarantined or otherwise self-contained? *

Yes — I'm self-quarantined because I am showing or have shown symptoms

Yes — I'm self-quarantined because I'm high risk or exercising extra caution

If you are currently self-quarantined or self-contained, please list the start date.

YYYY

If you are currently self-quarantined or self-contained, please provide the projected end date (if known).

In the space below, please select which areas you have a need for at this current time. Leave any non-applicable items blank. Please note that we will make every attempt to connect needs to organizations and volunteers that can fill these needs, but cannot guarantee service. *

Food pick up and delivery (if you are able to utilize a service that can deliver food to your home, please do so).

Supplies delivery (if you are able to utilize a service that can deliver food to your home, please do so).

Petcare

Medication delivery

Encouragement

Neighborly support

Reference to Mental Health resources

Yardwork

Food donation

Childcare

Tutoring Services

Other:

Required

Please provide details (date/time/location of an appointment, ages of those needing care, types of supplies needed, location of pharmacy, etc.) below. *

Do you anticipate needing one-time or continual support? Please give as much detail as possible (for example: daily support for animal care, weekly assistance with yard work). *

Is there any additional support you may need in the future?

Financial (for purchasing groceries and supplies, etc.)

Technological (for ordering supplies online)

Delivery (for getting items to your home)

Other:

Please let us know anything that may be helpful as we find a volunteer match, including household information (ages of family members, etc), if applicable.

If there are children living in your household, and you feel comfortable sharing, please provide the school they attend.

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