Requesting Free CBD to Distribute

Question Title

* 1. Info about Org/Individual Requesting Free CBD to Distribute

Name of Organization

Mission Statement of Organization (if applicable)

Contact Person (First and Last Name)

Street Address (location where CBD can be delivered)

City

State

E-mail

Phone

Question Title

* 2. Date of request

Today's date

Date

Question Title

* 3. How many bottles of 3,000 mg CBD oil would you like to request? We recommend giving 1 bottle per individual—which is a 1-3 month supply depending upon dosage of between 33-100 mg per day—and providing more if/when they run out.

Note: Additional bottles can be requested from SFHC via an additional online form once you have distributed at least 70% of your initial request.

72

144

Question Title

* 4. SFHC is currently located in Taos, New Mexico and is able to arrange a free delivery if your org is located within 50 miles of Taos.

My org is within 50 miles of Taos and can receive a delivery at the address listed above

My org is more than 50 miles from Taos and can pick up CBD at SFHC HQ

Other (please specify)

Question Title

* 5. Who will your org provide free CBD to (check all that apply)

Individuals experiencing homelessness

Individuals experiencing housing insecurity

Low/no income individuals

Residents/members of Pueblos/Reservations

Service workers/staff/volunteers

Question Title

* 6. Which symptoms do you think your participants will want to use CBD to address (please rank, it's fine to guess)?

Question Title

* 7. How do you plan to distribute medicine to participants?

Question Title

* 8. How do you plan to track feedback/health outcomes from participants (formally or informally)?

Question Title

* 9. Are you able to provide anonymous feedback/testimonials from one or more participants about their reasons for using CBD, their self-reported health outcomes, and if/how free CBD impacted their lives?

Question Title

* 10. Thank you for helping SFHC get this free medicine to people in need! Let us know if you have any additional questions or input (including additional orgs/individuals who we should contact to support distribution to their community).