UChicago Medicine COVID-19 Supply Donation Form

Please fill out the contact information and product details. A member of the PPE Donations team will respond to all inquiries. For donation questions, please email covid-donations@uchospitals.edu

Contact Information

Contact Name*

Organization

Contact Email*

Contact Phone*

Are you going to drop off or ship your donation?*

Drop Off

Mail / Ship

Address

If shipping product, please provide location shipping from

*Donations of a pallet or more should contact covid-donations@uchospitals.edu before shipping

Item Information

Please provide as much detail as possible

Mask Details

Provide Manufacturer, MFG part number, Description, and Quantity

Gown Details

Provide Manufacturer, MFG part number, Description, and Quantity

Goggles/Face Shields Details

Provide Manufacturer, MFG part number, Description, and Quantity

Bodysuit Details

Provide Manufacturer, MFG part number, Description, and Quantity

Disinfectant Wipes Details

Provide Manufacturer, MFG part number, Description, and Quantity

Other Supplies

Provide Manufacturer, MFG part number, Description, and Quantity

Comments

Please contact covid-donations@uchospitals.edu if you have any questions.

Supply Donation Information

Donations can be mailed/shipped (preferred) to: Knapp Center for Biomedical Discovery (KSBD) Attn: DAN TIBERI-PPE DONATION 900 East 57th Street Chicago, IL 60637 Donation Drop Off: Knapp - KSBD 900 East 57th Street, Hyde Park East Loading Dock 8am - 4pm, Monday - Friday

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