Count

Please provide counts of masks that you’ve sent to facilities listed on the Locations page of our website. This form is only being used to track fulfillment of requests.

Your Name or Organization*
Your Email*
# of Masks Sent*
Who did you send to?*
Please only report masks sent to a facility on our Locations list.
What state is the facility that is on our list located in?*
Name
This field is for validation purposes and should be left unchanged.