PPE and other Med Supply Requests for COVID-19

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The form is created to collect PPE and other Medical Supplies in relief to COVID-19 crisis. If needed, please fill in your specific needs. It is created and maintained by with The Hopkins Club for Innovation and Entrepreneurship, a Johns Hopkins alumni let 510(c)3 organization. Despite the fact that we strive to help each and any one, the request will be addressed properly as deemed by the committee. More about us, visit www.hopkinsclub.org. Any questions? Please contact info@hopkinsclub.org.

Email *

Your Name *

Your Department *

Your Affiliation *

Johns Hopkins Hospital

Johns Hopkins University

Other Johns Hopkins affiliates or advocates

How many of your colleagues are still working and in need? *

0-10

11-50

51-100

Over 100

PPE/Medical Supplies in Needs *

N95 Mask

Surgical Masks

Coverall

Shield

Gloves

Other:

Quantities in need? You may pieces based on two-week duration. *

Any additional information for your request? *

Best number to contact you? *

Your delivery address? *

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

Forms