Appointment Request
By filling out this form, you are requesting assistance from United Ministries with either your rent or a utility bill. Upon receiving your request, we will give you a call as soon as we are able. Please note, due to the sheer volume of requests we receive, we are only able to call once.
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Have you received assistance from United Ministries on 3 or more occasions? *
Do you have a child 18 years old or younger living in your home? *
Are you experiencing a verifiable crisis? *
For example: A job loss or unexpected expense. You will need to provide some proof.
Will you be able to support yourself after this crisis? *
For example: You will earn enough to support yourself.
Do you belong to a Native American tribe?
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First name *
Last name *
Date of Birth *
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Phone number *
Email address
What type of help do you need *
What is the amount of the bill in question? *
how much do you owe on the utility bill or monthly rent?
Describe your situation and your crisis event. *
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