Request Assistance
Complete this form to request support or resources from Lemon Aide Project. Be ready to provide your details and needs.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City / County
*
Type of Assistance Needed
*
Please Select
Emergency Supplies
Disaster Relief Support
Evacuation Resources
Preparedness Information
Narcan Host Box Information
Volunteer Support Request
Other
Please tell us what support or resources you are seeking.
*
Please check all that apply:
Urgent Need
Family with Children
Senior Support Needed
Disabled or Medical Needs
Pet Assistance Needed
Other
IMPORTANT:
Lemon Aide Project is a nonprofit organization and response capacity may vary based on current emergencies, volunteer availability, and available resources. If you are experiencing a life threatening emergency, call 911 immediately.
SUBMIT REQUEST
Should be Empty: