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COVID Relief Request

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COVID RELIEF REQUEST

Famicos Foundation is concerned about the health and well-being of those we serve during this pandemic, especially members of vulnerable populations. To help you to continue to shelter in place, and to help alleviate the need of having to go out in the community to purchase essential items, we have received generous funding to be able to distribute food, toiletries, and disinfectants to our residents for free during this pandemic. If you live in Ward 7 (Hough), Ward 9 (Glenville), or ward 10 (St Clair-Superior) and you are a senior (60 years or older) or have a disability or have a compromised immune system, you can request essential items using this form. We cannot guarantee that you will receive everything you request, but we are doing are best to make deliveries once a week. If you have any questions, please call us at (216) 791-6476.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED
  What address would you like the items to be delivered to?
  Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- I live in a... REQUIRED Please fill out this field.
- If you live in a house, are you in need of home repair?
- I am a resident of... REQUIRED
  Which Ward do you live in?
  Please fill out this field.
- I...
  Check any that apply
  am 60 years of age or older have a disability have a compromised immune system lost my job due to COVID-19
- Are there children in the home?
- If so, how old and how many? Please enter valid data.
- Do you need food from the Food Bank delivered to your home/apartment? REQUIRED Please fill out this field.
- Do you need toiletries delivered to your home/apartment? REQUIRED
  Toilet paper, deodorant, hand soap, etc.
  Please fill out this field.
- Do you need disinfectants delivered to your home/apartment? REQUIRED
  Rubbing alcohol, disinfecting wipes, etc.
  Please fill out this field.
- We cannot guarantee which specific foods you might receive from the Food Bank. We do understand that there is a particular need for perishables right now. Also the type and number of toiletries we have is based on the donations we are getting in.
- Is there anything else you need urgently? Please enter valid data.
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