Hotel/Motel Assistance Contact Form
To appropriately gauge the current level of need for Hotel/Motel Assistance in our community, please place the name and contact information for any potential person(s) who is either at-risk of losing their current hotel/motel stay due to changes in their economic circumstances or who are currently experiencing an episode of homelessness.

Please note that submitting this form in no way guarantees assistance for any person(s) or services from any organization. Each person who submits a form will be contacted regarding their current need in as timely a manner as possible.

Unfortunately, at this time this process is not able to assist potential clients who are at risk of being unable to pay either their rent or mortgage.
Name *
Email *
Phone number
Current Hotel/Motel (If applicable) *
Current City
Current Living Situation if not Hotel/Motel
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