Request for Support

We want to support you in your time of need as the CoronaVirus continues to impact lives in various ways. Please let us know how we can help and care for you. Complete the form below and our care team will follow up with you. Please know that your personal information will be confidential and only used by the care team to support you.

Name*

First Name

Last Name

Phone Number*

Email*

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Christ Lutheran community:

I am a Christ Lutheran Church member. I attend Christ Lutheran Church for worship and/or participate in online worship. My child(ren) attends Christ Lutheran Preschool. My child(ren) attends Christ Lutheran Day School.

Other:

I am considered in the high-risk or vulnerable person category:

Yes No

Other:

Please share how you've been impacted:

I am in need due to the "Safe At Home" orders and business closures. I am not able to leave my home due to self-isolation or quarantine. I am feeling disconnected or isolated from my community. I have noticed a change in my mood that concerns me and/or I am less interested in activities I previously enjoyed. I am having trouble accessing medical resources. One or more individuals in my home are sick (unconfirmed COVID-19). One or more individuals in my home are sick (confirmed COVID-19).

Please identify your current needs below:

Prayer Video Call Phone Call Errands Proper Nutrition or Meal Planning Financial

Other:

Share with us about your needs: