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Application for contact free delivery of personal hygiene and cleaning supplies

See The World Education COVID-19 Program

1.Applicant Name:(Required.)
2.Is there someone assisting to fill out this application?(Required.)
3.Please state the reason you need personal hygiene and/or cleaning supplies delivered. (This program is focused on helping individuals with disabilities or who are in dire need of resources to stay clean and healthy. We prioritize applicants who are disabled and do not have assistance or finances to leave their home and to purchase these necessary items.) questions: How many people are in your household?Are you helping or sharing this donation with others? For example family or friends you are supporting or dependent on you?(Required.)
4.What types of Personal Hygiene/Cleaning Supplies do you need?(Required.)
5.What types of Personal Hygiene/Cleaning Supplies do you need?(Required.)
6.What types of Personal Hygiene/Cleaning Supplies do you need?(Required.)
7.What is the address of the individual in need of no contact delivery?(Required.)
8.Program Terms of Service: By submitting this form for application of non-contact delivery, you are consenting to understanding that See The World Education,Inc. is not liable for any occurrences, situations or damages that should happen in affiliation with the program to any degree. See The World Education will never share any of your personal or private information with anyone else. I fully understand that completing this application does not guarantee participation. Information provided to See The World Education will remain private and will not be shared with 3rd party affiliates.(Required.)
9.Media Consent and Release: See The World Education would like to promote the program and help as many people as possible in need by taking pictures and video of supply delivery. Check yes if you are consenting to media and marketing.(Required.)