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Help Request
If you are in need of assistance. Please read below.

In order to best determine what assistance may be available to meet your request, a short financial assessment will be done when we contact you. Please have your total household’s income and expense information ready at the time of our call.

We will do our best to contact you as soon as we can. Requests will be answered in order that they are received.

Please continuing contacting our helpline at 394-5411.  We are open Monday through Thursday 9 am - 3 pm.  If after hours, please contact 211.
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First Name *
Last Name *
Last 4 digits of social security number *
Address (please include apt/lot #) *
City
Phone Number *
Email Address
What type of assistance do you need *
Required
Number of adults living in household (over 18 years of age) *
Number of children living in household (18 years of age or under) *
Is anyone employed in the home? *
Does your household receive? (Please check all that apply) *
Required
Total Monthly Income (Please include all sources of income except food stamps) *
In order to best determine what assistance may be available to meet your request, a short financial assessment will be done when we contact you.  Please have your household's income and expense information available.
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