I want to help someone in need during COVID-19

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

While the Coronavirus is attacking the health of friends and loved ones, it is also causing financial hardship for many. For some of us, we are blessed to maintain our jobs during this time, and many are looking for ways to lend a hand to others at this time. For example, our family will receive a stimulus check that we do not need because our personal economy has not been affected. Therefore, we would like to find a way to give that money to others who could use it.

Please complete this form if would like to help or support someone who is experiencing hardship during this global pandemic. We are actively gathering information about people in our communities who need a hand, and we will use the information you input to try to connect you with someone you can help and extend love/service to during this global pandemic.

Please know that we are not an organization. We are simply of group of citizens who believe in the good in all people. We would like to do our part to help connect those who are looking for ways to help with those who could use a hand during this difficult time. Thank you for taking the time to fill out this form and for allowing love to triumph during this difficult time.

If you have any questions, you can reach us at jnoyaquintana@gmail.com or 412-865-7558.

"It may be stormy now, but rain doesn't last forever." This form is your way to help extend an umbrella to someone during this time of Coronavirus.

Your Full Name *

Your Email Address *

Your Phone Number

Preferred Social Media Platform

Instagram

Facebook

Twitter

Other:

Clear selection

Username on your preferred social media platform

Do you use WhatsApp? *

Yes

Location (not your exact address - just city/general neighborhood) *

How would you like to help during this time? (Check all that apply) *

I would like to help someone pay some of their rent to maintain their housing during this time

I would like to give a financial gift to someone for other needs they have during this time.

I would like to secure food or supplies for someone in need

I would like to help someone solve a household challenge they are facing (ex: broken air conditioning, medical bills, etc.)

Other:

Required

What is the best way to reach you when we have found someone who could benefit from the love/service you want to extend? *

Phone

Social Media

Other:

Required

Is there anything else you would like us to know about you (about your capacity to give, your reasons for giving, etc.)?

If we successfully put you in contact with a person or family to help/serve during this time, will you commit to communicating with us to let us know what help has been provided so that we can keep track of progress made and remaining needs for support? *

Yes

We believe that in this world there are far more people who seek to extend love and do good in this world than those who seek to do harm. Nevertheless, it is impossible of us to know everyone's intentions. Please sign your initials below to affirm that the information you have input into this form is accurate and honest. *

Comments or anything else you would like to tell us

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