Assistance Request Form
By completing this form, we will be able to coordinate workforce services for job seekers and employers. Your completed request will be forwarded to someone who can assist you and address your need. We will do our best to respond to your request in two business days.
What can we help you with?
Employment (Job search, Resume Assistance, Interviewing)
Unemployment benefits Information
RESEA / ROW Workshop (notification)
YouthWorks Summer Jobs (Age 14 -21)
Returning Citizen Services
Criminal Background/Legal Assistance Referral
Disability Services (DORs)
GED/Adult Education Services
Food, Interview Clothing, or Housing
Computer, Fax, Phone, WIFI Access
Speak to a Specific Staff Member
If you selected speak to a specific staff member above, what is the name of the staff member who you'd like to speak with?
First Name and Last Name
MOED has many services that anyone can use, but in some cases our services are specific to certain people. In order to help us assist you, we ask you to complete the following questions.
Are you a new or returning customer?
In which of the age ranges below, do you fit in?
14 - 17
18 - 21
22 - 24
25 - 54
55 and above
Are you a veteran or the spouse of a veteran?
Neither a Veteran or a Veteran's Spouse
Are you currently unemployed?
Individual (family, friend)
Social Media (FB, IG, Twitter or other)
If you selected "Service Agency" above, what is the name of that "service agency?"
Are you filling this form out for yourself or on behalf of someone else?
I'm completing for myself
I'm completing for a friend or family member
I'm with an organization and helping a client of mine
Is there anything else you'd like us to know?
Page 1 of 2
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service