COVID-19 Kits for Migrant Workers Request Form

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You can fill out this form to request up to five free COVID-19 kits from Legal Aid of Nebraska in partnership with the National Center for Farmworker Health to distribute to migrant workers in your community. Each kit contains N-95 masks, hand sanitizer, sanitizing wipes, latex gloves, disposable thermometer and a pulse oximeter packaged together in a reusable drawstring bag.

How many kits do you need? *

Organization *

First Name *

Last Name *

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Phone Number

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