Local COVID Resources - New or Updated Info

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* 1. Provide the business/organization contact and location information here. We will use this address to map your location.

Name of business/organization providing free resource *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address

Phone Number

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* 2. If the name of the pick up location is different from the name provided above, please indicate the name of the pick up location here.

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* 3. Describe what is being provided and how here. Specify whether you are providing pick up or delivery services.

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* 4. What days of the week and hours are the resource(s) being provided.

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* 5. What is being provided? At this time we are only listing food resources.

Free Coffee

Free Meals

Free Pantry Items

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* 6. How many meals do you think can be provided on a daily basis?

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* 7. If you have a link for more information, please paste that link here.

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* 8. Is there a specific target audience? If so, please check the boxes below.

Youth

Seniors

Service Workers

Medical Workers

Other Public Service Workers

Anyone in Need

University Faculty-Students-Staff

Unsheltered Individuals

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* 9. Provide contact information for the person completing this form here.

Your Name

Email Address

Phone Number

Local COVID Resources - New or Updated Info

Question Title

* 1. Provide the business/organization contact and location information here. We will use this address to map your location.

Question Title

* 2. If the name of the pick up location is different from the name provided above, please indicate the name of the pick up location here.

Question Title

* 3. Describe what is being provided and how here. Specify whether you are providing pick up or delivery services.

Question Title

* 4. What days of the week and hours are the resource(s) being provided.

Question Title

* 5. What is being provided? At this time we are only listing food resources.

Question Title

* 6. How many meals do you think can be provided on a daily basis?

Question Title

* 7. If you have a link for more information, please paste that link here.

Question Title

* 8. Is there a specific target audience? If so, please check the boxes below.

Question Title

* 9. Provide contact information for the person completing this form here.

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* 10. Provide any additional comments or explanation regarding your responses here.