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Assistance request
The Resource Center is your first step to support. This form serves as a first point-of-contact for Hawai’i County residents who may need guidance connecting to community resources. If you are in need of assistance, complete the form below. 

We will contact you within 2 business days to see what services you may qualify for and direct you to the best agencies and/or programs. 

You may also call or text our Resource Center at (808) 501-1413.

This is not an application for services; this is a request to receive help connecting to other agencies

We do not provide financial assistance for rent and utilities at this time

Please complete the information below. A Community Resource Navigator will contact you to see if there are resources that may be able to assist you.
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Consent *
By submitting this form, you give Neighborhood Place of Puna the permission to release, obtain and verify all pertinent information with the individuals and agencies offering the services you are requesting. Those who receive this information cannot disclose it to others without further consent. This consent has been made freely, voluntarily, and without coercion. 

Please select Yes if you give your consent. Once the referral form is received, NPP will follow up within 2 business days. 

To ensure quality of service and success of the referrals given, NPP staff will conduct a 1 month follow-up via phone call.
Current housing status *
First name *
Last name *
Preferred name *
Your date of birth *
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DD
/
YYYY
Phone number *
If you do not have a phone number, please enter 0
Does this phone number belong to you? *
If the phone number provided does not belong to you, does NPP staff have permission to ask for you by name and identify our agency and services? *
Do you consent to receive text messages from Neighborhood Place of Puna?  *
Email
Best form of contact *
Gender *
Zip code *
Please note that we are a Hawai'i County program.
Where did you sleep last night? *
Unsheltered: best possible description of where you slept, be as detailed as possible.
Sheltered: Either enter the name of the Emergency Shelter/Transitional Housing or enter N/A Sheltered
Do you identify with any of the following? *
Required
How many people are in your household? *
Including yourself
How many minors are in your household? *
(Children under the age of 18)
Total number of minors (0-5 years of age) *
What services are you seeking? *
Please note that our agency may not provide the services listed below, but we will connect you to any other agencies that do if you are found eligible. 
Required
Have you contacted other agencies regarding the services you are seeking? *
If yes, please list the agencies below. 
Please describe your request for services *
What is your primary language?  *
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