Get Help

The Covid-19 crisis has exposed a lot of gaps in our capacity to serve at risk populations, especially seniors. Do you need to hear a friendly voice ? Need help picking up groceries, prescriptions or food boxes ? Help with the Census? is there a program that would help you but you can’t get the paperwork done by yourself ? Fill out the form below and we’ll do our best to find you some help.

Get Help Submission Form

Consent Signature

Consent Signature is required. Typing your name in the box and submitting your application implies consent to receive volunteer services and agreement to the following: In order to connect you to people/agencies that can help you, we ask you to allow us to share your information with those providers.
Your information will be kept confidential and will be only used to help you get the services you want. Some providers may ask you to sign another consent or authorization to share your information and follow federal, state, and local privacy and data protection laws, including federal HIPAA laws. Services providers and/or Corona Virus Update may contact me by phone, email, text, fax or mail to help me get the services I need and to follow up on my status with and experience with those services. I understand that the information sent to me may contain sensitive information that I may not be able to secure.
I will not hold Corona Virus Update or any participating agency legally responsible if I do not get services or am unhappy with the services I receive. If I am signing as a personal representative of another person, I am affirming that I am legally allowed to sign this release of information for that person.
If I am under the age of 18, I understand that a parent, legal guardian, personal representative, or other legally allowed person has to sign this form for me.

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