Request PPE
If you are a Colorado healthcare facility, frontline worker or primary school (K-12) and can’t afford to purchase PPE, please complete this short questionnaire so we can process your request as quickly as possible. Thank you!
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What is the name of your organization or school? *
What type of facility is this?
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How did you hear about Make4Covid?
Name (First and Last) *
Best Contact Number *
Email *
Preferred Contact Method (select as many as you'd like) *
Required
Preferred days and times to contact you? *
What is the street address for delivery? (no P.O. Boxes) *
City *
State *
Zip code *
Please let us know if you have any special delivery instructions
How many full face shield units do you need (fits high school kids and up)? Note that these are reusable. (if none, please enter 0) *
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How many additional clear shield units do you need? Note that these are reusable. (if none, please enter 0) *
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How many face mask ear savers do you need? (if none, please enter 0) *
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How urgently do you need this equipment? *
Required
Please let us know if you have any of the following additional PPE needs.  We’re continually working on getting other equipment designs approved and we will notify you if they become available. (Select all that apply)
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