Request edit access
Majority Leader Stewart-Cousins' PPE Distribution
NYS Senate Majority Leader Andrea-Stewart-Cousins is distributing face masks,  gallon-size hand sanitizers, travel -size hand sanitizers in bulk to community organizations, businesses, non-profits, and religious organizations in the 35th Senate District. The 35th SD includes parts of Yonkers, New Rochelle, White Plains, Scarsdale, Hartsdale, Elmsford, Ardsley, all of Greenburgh, as well as the Rivertowns (Dobbs Ferry, Tarrytown, Irvington, and Hastings-On-Hudson). Please note that quantities may be limited in order to accommodate as many groups as possible. PPE pick ups must be arranged in advance at our district office: 28 Wells Avenue, 5th Floor Yonkers, NY 10701, or by calling (914) 423-4031.  
Sign in to Google to save your progress. Learn more
Email *
Name of Organization requesting masks *
Organization Address *
Contact Name *
Contact Number *
Contact Email *
Number of masks requesting *
Number of hand sanitizers requesting (please specify whether you would like travel Sized  or gallon Sized Sanitizer or both) *
Please provide your availability for picking up the masks at our district office: M-F between 10 am- 4 pm. **Masks and social distancing required for pick up** *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy