Online Forms

City of Eugene COVID-19 Resource Offer

2. Instructions
   Please use this form to provide information about resources you and/or your organization can make available for public use. Please add as much details as possible. Readily available resources and information can be accessed here:

   Please use this form to provide information about resources you and/or your organization can make available for public use. Please add as much details as possible. Readily available resources and information can be accessed here:

4. Updated information regarding the City of Eugene actions and resources to address the COVID-19 can be found here:
   Updates on COVID19

8. Contact information
   Your information will not be shared with the general public. It will be used by City of Eugene staff and partner agencies to contact you about the resources you are making available

   Your information will not be shared with the general public. It will be used by City of Eugene staff and partner agencies to contact you about the resources you are making available

10. Organization Name

12. First Name*

13. Last Name*

15. Address Contact*

17. City*

18. State Name*

19. ZIP*

21. Email*

22. Phone*

23. Extension

27. Type of resources you want to make available*
    -- Select One --Medical suppliesMedical servicesFood and cateringCleaning and hygiene suppliesHousing and shelterTransportationCleaning and sanitation servicesChildcareElder careEducationFinancial assistanceOther

    Please select the category that best describes the type of resources you can make available for public use

29. If other, please describe it here:

31. Description*

    Please describe in details the resource/service you are making available

33. Cost*

    Is there a cost for the resources/services you are making available?

    1. The service/resource is free
    2. The service/resource has a cost
35. Describe the cost of the resources/services

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field