Donation Form
We are grateful for the support of Texas's coronavirus response efforts.
Please submit one product per form submission.
Contact First Name
Contact Last Name
Role Position Title
Phone Number
Email Address
Type of Organization or Individual
Select
Public Sector
Nonprofit
Private Sector
Individual
Organization Name, if applicable
Organization Website, if applicable
Type Of Offer
Select
Donated Goods (e.g., medical supplies)
Donated Services (e.g., volunteer time)
Paid goods/services (e.g., sales of supplies)
Donated Use of Space or Facility
Ideas/suggestions
Category of Offered Good, Service, or Space
Select
Good – Medical (Personal Protective Equipment: Surgical Masks)
Good – Medical (Personal Protective Equipment: Respirators)
Good – Medical (Personal Protective Equipment: Goggles / Glasses)
Good – Medical (Personal Protective Equipment: Respirator/Masks)
Good – Medical (Personal Protective Equipment: Gowns/Covers)
Good – Medical (Personal Protective Equipment: Gloves)
Good – Medical (Personal Protective Equipment: Other)
Good – Medical (Specialized Equipment: Other)
Good – Medical (General Equipment: Sampling Materials)
Good – Medical (General Equipment: Testing Materials)
Good – Medical (General Equipment: Hospital Bed)
Good – Medical (General Equipment: Other)
Good – Non-Medical (Canned or Bottled Water)
Good – Non-Medical (Non-Perishable Food Items)
Good – Non-Medical (Electronics: Batteries)
Good – Non-Medical (Electronics: Flashlights)
Good – Non-Medical (Electronics: Communication)
Good – Non-Medical (Electronics: Other)
Good – Non-Medical (Paper Products)
Good – Non-Medical (Hygiene Products)
Good – Non-Medical (Cleaning Products)
Good – Non-Medical (Unused Bedding)
Good – Non-Medical (Other Necessities)
Service – Technical (Information Technology)
Service – Technical (Legal)
Service – Technical (Financial)
Service – Technical (Medical)
Service – Technical (Professional Education)
Service – Technical (Other)
Service – Non-Technical (Administration)
Service – Non-Technical (Clerical)
Service – Non-Technical (Transportation)
Service – Non-Technical (Child Care)
Service – Non-Technical (Senior Care)
Service – Non-Technical (Animal Care)
Service – Non-Technical (Other)
Space – General (Storage)
Space – General (Manufacturing Center)
Space – General (Distribution Center)
Space – General (Parking)
Space – General (Large Center, Hall, or Indoor Space)
Space – General (Small Center, Hall, or Indoor Space)
Space – General (Other)
Space – Specialized (Medical In-Patient Facility)
Space – Specialized (Medical Out-Patient Facility)
Space – Specialized (Call Center)
Space – Specialized (Videoconferencing Center)
Space – Specialized (Hotels, Motels, or Lodging)
Space – Specialized (Telemedical Center)
Space – Specialized (Other)
Description of Offered Good, Service, or Space
Address of Offered Good, Service, or Space
City of Offered Good, Service, or Space
State of Offered Good, Service, or Space
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip of Offered Good, Service, or Space
Quantity
Available From
Available Until
Please advise what if any, assistance is needed to accept, transport, deliver and/or use the offered good, service, or space.
e.g., retrofit space, pick up supplies