Love INC Assistance Request Form
We at Gallatin County Love In the Name of Christ know that asking for help can be hard. We want you to know we don't judge you or your situation. We want to help in any area we are able to.

We are a call center, which means we do all client intake and volunteer matching over the phone. But you can get a jump start on the process by filling out some basic information on this form.

Love INC serves residents of Gallatin County. We are not an emergency service. We believe in taking time to hear your story and help you come up with solutions. Part of the Love INC process is the verification of information shared. When contacted by Love INC, please be prepared to engage in the process.

Once Love INC receives this initial form, a volunteer will contact you by phone to complete your request. Due to our volume of requests it may take up to seven business days for a volunteer to contact you.

Form submissions are sent over an SSL encrypted connection.

Full Name (First, Middle, Last) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Please provide your primary phone number that we can use to contact you.
Your answer
Is this a mobile number? *
If yes, who is your cellular provider?
Your answer
Secondary Phone
Please provide a secondary phone number if your primary phone number is not reliable.
Your answer
Who lives in your household? Please provide names, relationships, and birth dates. *
Example: I live with Joe, my husband, 2/5/1964 and Sue, my daughter, 11/14/2008.
Your answer
Physical Address *
Where do you live? Please include street name, number, city, and zip code.
Your answer
Are you a resident of Gallatin County? *
Note: Love INC services are limited to residents of Gallatin County. If you live outside the county we may be able to brainstorm options and referrals with you, but we won't be able to activate any of our volunteers to help meet your need.
Have you ever contacted Love INC before? *
Referral
If you are a new client, how did you hear about Love INC?
Your answer
Assistance Request *
Please indicate what you are seeking assistance for. There are no guarantees Love INC will be able to assist with your request, but we will listen, problem solve with you, and do our best to come up with an appropriate solution.
Your answer
Almost Done!
The information provided in the following questions allows Love INC to better assist you with your request(s).
What transportation is available to you? *
If approved, some Love INC assistance will require you to travel to an appointment within our Partner Church Network. If applicable, select more than one.
What is your housing situation? *
What is your employment situation? *
What is your estimated monthly income? *
Your answer
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