Request for Assistance - Intake Form
Please complete and submit the form below so that we can better understand your situation and how to best support you. Answers will be kept confidential by union representatives. A member of the Local 0789 team will be in touch shortly! Fields marked with an * are required. 

Here’s what to do:
  1. Fill out your contact information. Make sure we have the best way to reach you (phone and email).
  2. Briefly describe what you are reaching out to us about. Share a short summary of what’s happening and how it’s affecting you. 
  3. List any and all deadlines or timelines related to this issue that you are aware of.
  4. Submit the form.
  5. Once we receive your request, our team will review it and follow up with you to gather any additional details—like important dates, timelines, and supporting documents.
  6. You’ll be contacted by a steward or representative to discuss next steps.
If you have any questions or need help filling out this form, please email us at AFGEL0789@gmail.com.

Please be advised that a failure to fill out this form completely and accurately may result in delay in the processing of your request.
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Email *
Firsta Name *
a *
Contact Email Address (non-VA) *
Contact Phone Number *
Job Title/Position *
Department *
Are you a member in good standing of AFGE? *
Please identify the best times to reach you below (select all that apply).  *
Required
Please identify your preferred method of contact below (select both if you have no preference).  *
Required
What happened that caused you to reach out to us? *
Are there any deadlines related to this request that you are aware of? If so, please list the deadlines below.
A copy of your responses will be emailed to the address you provided.
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