Referral for Assistance
Complete this form for yourself or a client who is in need of assistance. An SHC staff member will then contact the individual seeking services within 2 weeks. If you are requesting assistance in an eviction situation, please call the office or walk in for immediate services. (617)623-6111
Full Name *
Phone Number
Email
Which way do you prefer to be contacted?
Clear selection
What is your current housing situation?
Clear selection
In what town are you currently staying?
What agency were you referred by? (if any)
What do you need assistance with?
Please provide a brief explanation of your situation
Submit
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