Refer a local need (Warren county NC and surrounding)
This information is kept confidential, we will determine if we are able/how best to address the need/crisis referred. You choose whether you wish be informed of our outcome if you would like to be informed. Also please choose whether you wish to remain anonymous, in which case we won't share your information but we do require it for our internal confidential records and in the event we need to get more information.
Your Name
Your answer
Your contact number (with area code)
Your answer
Email address
Your answer
Do you mind if we share who referred us to assist the person(s) in need?
Name of the person(s) in need/crisis
Your answer
Address of person(s) in need/crisis
Your answer
Phone number of person(s) in need/crisis
Your answer
Nature/type of the assistance needed
How many person(s) and approx ages
Your answer
Other/notes/also (Anything you wish to add feel free to put it here)
Your answer
Do you wish to be contacted regarding our outcome on this matter?
Be on notice that we can't promise that we can assist with every need, nor that everyone offered assistance will accept it. We will do our best to address the need brought forward. We do so without discrimination based on any factors, and seek to alleviate needs as best we can, but don't offer assistance in ways that contribute to harmful outcomes. We not able offer cash assistance. You understand accept these conditions.
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