Pastoral and Financial Assistance Intake Form For Flood Impacted Families and Individuals
Please fill out this form if you or a family member are in need of pastoral/emotional and or financial assistance.
First Name
Your answer
Last Name
Your answer
Street Address
Your answer
Zip Code
Your answer
email address
Your answer
Tel #.
Your answer
Synagogue Affiliation
Your answer
Would you like R. Gelman to call you?
Would you like to speak with a licensed mental health professional?
If it is available, would financial assistance be helpful?
Who in your household needs assistance?
Please provide as many details as you feel would be helpful
Your answer
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