Care Collective Los Angeles Volunteer Intake Sheet

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Thank you so much for offering to get involved with our effort to connect and support vulnerable Angelenos during this pandemic.

This form allows us to connect volunteers to people in need as well as to assess what kinds of skills, resources and capacity we can bring to this effort.

At Care Collective LA, those of us within these communities have identified how our needs can be best served. We are entirely volunteer-based and lead by organizers from these specifically vulnerable communities. We will be raising funds and connecting volunteers to work to make sure those most at-risk in this pandemic don't go without basic needs.

To learn more, visit: https://linktr.ee/CareCollectiveLA

Name *

Pronouns (if you feel like sharing)

Phone

Email *

Instagram or other social media you'd like to list

What's the best way to contact you? *

Phone Call

Text

Instagram

Other:

What neighborhood is closest to you? *

East San Fernando Valley

West San Fernando Valley

West LA

Downtown LA

Northeast LA

East LA

Central LA/Hollywood

Mid-City

Santa Monica/Venice

South LA

Pasadena

East San Gabriel Valley

West San Gabriel Valley

South Bay / Harbor Cities

Long Beach

Do you have access to a car that you are able to drive?

Yes

Sometimes

Clear selection

Are you, or is someone you're around consistently, particularly vulnerable to COVID-19?

We want to make sure we don't put elderly, disabled or immune compromised folks at further risk. Everyone will have something to offer this effort, this will give us an idea of how you can plug in.

Yes

Clear selection

Are you connected to any relevant organizations or communities? If yes, please list them.

Do you have any experience in any of the following areas? List any that you feel might be relevant.

Fundraising

Social Media

Community Organizing

Translation

Data Entry

Caregiving

Budgeting

Navigating public benefits

Mutual Aid

Cleaning

Cooking

Childcare

Art

Health care

Other:

Would you be at all interested in joining any of the following teams?

Fundraising/Budgeting team- Help us raise and allocate money to pay for care and supplies.

Communications team- Help spread the word about our work. This could be via social media, in person or through other means.

Recruitment team- Help us find people who are able to work as caregivers or join our other efforts.

Care team- Help us meet the needs of folks who need support and care in their homes.

How many hours a week are you capable of offering to help support this work?

We understand this can be hard to estimate and can change. Please take your best guess.

1-2

3-5

5-10

10-15

15-20

20-30

30+

Clear selection

Are you able to donate or share any of the following supplies?

Groceries

Prepared food

Toilet paper

Paper towels

Soap

Gloves

Alcohol Wipes

Hand sanitizer

Rubbing alcohol

Water

Other:

Do you have any access needs you would like us to know about?

Are you able to offer financial assistance to our efforts to help those in need?

We understand that not everyone is a position to help in this way at the moment and we appreciate your volunteering! We would love it if any of you could spread the word of our fundraising efforts once they're off the ground.

Yes

Clear selection

Submit

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