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Nonprofit COVID-19 Response Request Form
Organization:
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Contact First Name
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Contact Last Name
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Street Address
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Address Line 2
City
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Zip Code
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Phone Number
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Email Address
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Our organization needs the following to support serving those in need (select all that apply):
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Additional supplies (select which items are needed below)
Volunteers
Other (please specify)
Other (please specify)
Supplies needed:
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food/snack packs
hygiene supplies
hand sanitizer
disinfecting wipes
other (please specify)
other (please specify)
Please tell us what types of volunteer work would be helpful:
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Are there resources/services that your organization is offering in response to the COVID-19 health crisis (i.e., offering child care for those who can't stay home - nurses, first responders, etc.)?
Are there any additional impacts/challenges that you are experiencing or foresee experiencing as this public health crisis continues?