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
Which way do you prefer to be contacted?
What is your current housing situation?
Place not meant for human habitation (streets, woods, etc.)
I am renting a house/apartment/room
Staying with friends/family (couch surfing)
I own my house/apartment
In what town are you currently staying?
What agency were you referred by? (if any)
What do you need assistance with?
Rental or utility arrears
First, Last and Security
Please provide a brief explanation of your situation
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This form was created inside of Somerville Homeless Coalition, Inc..