PIN Form | Pandemic of Love

Dear Community Member:

First, thank you for your courage. Asking for help takes strength and it's one of the bravest things you can ever do.

Please use this form to let us know what specific ways our community can come together to help you in your time of need.

Once you fill out the form, our team of dedicated (non-paid) volunteers will work on finding you a match. We will work to partner you with an individual or family that can help you meet all or part your indicated needs.

Sometimes our volunteers will require additional information from you, or ask for a copy of the bill you need paid, in order to help the donor process the need directly.

Depending on the current queue in this community, it may take as little as one week to match you, but sometimes it can take longer than a month. We work hard to process as many individual requests daily as possible, but we are also at the mercy of our available donor pool.

We will work hard to minimize your wait time to the best of our abilities.

PLEASE DO NOT FILL OUT THIS FORM MORE THAN ONCE. Rest assured that if you fill out the form once, it is in our system. By filling out the form more than once, you may cancel out your application completely or be put in the back of the queue.

Please also note that this is a manual matching process; actual human beings comb through requests and patrons and then send out customized emails to match each one.

This form will remain confidential, and our team will not share your personal information with anyone except your patron. We ask that you keep their information confidential as well. They will have been asked to do the same.

This is a humbling experience on both sides of the transaction – for the person in need and for the giver.

Sending you healing, love, and freedom from suffering.

Much love and gratitude,

Your Pandemic of Love Team

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* Required

Have you received assistance from Pandemic of Love before? * Yes No Email *

Please provide a valid email address.

First Name *

Please provide your first name.

Last Name *

Please provide your last name.

Age *

Please provide your age.

Best Phone Number to Reach You (w/ Area code, include country code if outside USA or Canada) *

Please provide a contact phone number.

Current Country

Current City *

Please provide your current city of residence.

Zip Code/Postal Code

State *

Please provide a your region.

Current Occupation(s) *

Please provide your most recent occupation.

Current Place(s) of Employment

Briefly Describe the impact of the pandemic on your income (150 words or less)*

Please describe your situation.

Please indicate the type and approximate cost range of the assistance you are requesting. (eg. Gas for my car $50, Month of medicine for blood pressure $200, etc.) *

Is there anything else about your current situation or circumstance that you would like for us to know or to consider when looking for a match or to convey to your donor? (eg. single parent, kids rely on free lunch in school, etc.) How did you hear about Pandemic of Love?

If you have applied in the last month and have not received assistance, PLEASE DO NOT APPLY AGAIN. If you are waiting for help, having already applied, please reach out directly to your community. You will find their contact information in the confirmation email that was sent to you when you applied.

Legal Notice: By hitting submit, I certify that I understand that Pandemic of Love is a grassroots, volunteer-run effort. We do not run background checks to verify the circumstances of each Person-In-Need, nor do we certify the ability of a Patron to donate prior to matching. This is a goodwill effort, run on love and faith in humanity and each other. Please note that by using this resource, you agree to hold harmless and absolve Pandemic of Love volunteers, donors and recipients of any and all liability. Thank you.

Need	Amount Needed	Describe
Assistance with paying for groceries	N/A $50 $100 $150 Other	No need for detail here
Assistance with gas for my car	N/A $50 $100 $150 Other	No need for detail here
Assistance with public transportation costs	N/A $50 $100 $150 Other	No need for detail here
Assistance with medicine, a pharmacy bill, or insurance premiums	N/A $50 $100 $150 Other
Assistance with a utility bill (electricity, water, etc.)	N/A $50 $100 $150 Other
Assistance with a car repair	N/A $50 $100 $150 Other
Assistance with toddler and infant needs such as diapers and formula	N/A $50 $100 $150 Other
Assistance with pet food/vet bills	N/A $50 $100 $150 Other
Something else	N/A $50 $100 $150 Other