Mutual Aid Weekly Check-In
Share your current needs, offers of help, and feedback to support our community this week.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
How are you feeling this week?
*
Great
Good
Okay
Struggling
Prefer not to say
Do you have any immediate needs this week? (Select all that apply)
Food/Groceries
Housing/Shelter
Medical/Health
Emotional Support
Childcare
Transportation
Financial Assistance
Other
Please describe your needs in more detail (if any)
Are you able to offer help to others this week? (Select all that apply)
Deliver groceries/supplies
Transportation
Emotional support/check-in calls
Childcare
Financial assistance
Other
If you are offering help, please specify your availability and details
Preferred method of contact
*
Email
Phone call
Text message
No preference
Would you like to participate in group activities or meetings this week?
Yes, in person
Yes, virtually
No, not this week
Additional comments or feedback
Submit Check-In
Should be Empty: