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COVID-19 Needs Form
COVID-19 Need Forms for Westchester County
Name
NAME
First
Last
Email
EMAIL
Phone
PHONE
Address
Full address
How have you been impacted?
How have you been impacted?
I or someone I live with is currently sick (Confirmed COVID-19).
I or someone I live with is currently sick (Unconfirmed COVID-19).
I am quarantined due to travel or recent exposure.
I am part of a vulnerable population group (60+ or immune-compromised)
I have needs due to the effects of the shutdowns.
What kind of assistance do you need?
What kind of assistance do you need?
Running an errand (to the grocery store, pharmacy, etc.)
Transportation (to doctor's appointment, etc.)
Tutoring for kids
A social connection (phone calls or visits)
Prayer support
Other
Please share a brief description of how we can help and/or pray for you below.
Please share a brief description of how we can help and/or pray for you below.
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