FREE MASK(S) FOR HOMELESS, LOW INCOMES, & VETERANS

Orpe Human Rights Advocates is currently serving only the States of Maryland, DC, & Virginia.

Providing free masks as our response to COVID-19

Please note that you are responsible for shipping fee of $4.00 (up to 6 masks). Your order will be served on first come, first served basis. In case of unavailability of the product, the organization will refund the shipping cost of $4.00 paid.

Name of household *

First

Last

Name of spouse

First

Last

Name(s) of child/children

Please provide the names of persons who need the masks.

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

How many kids do you have? *

None
1-2
3-6

How many masks do you need? *

Please send a proof of hardship. *

Click or drag files to this area to upload. You can upload up to 10 files.

Please send any proof that justify your state of hardship: for e.g. food stamp, TCA,... Note that each child included in this application must be justified by a proof of relationship with the applicant.

Email *

Facemasks shipping fee *

Price: $ 4.00

eSignature *