Please complete the form below to seek our community-based services (counseling, advocacy, groups or classes.) If you need emergency shelter, please call our 24/7 line at 1.800.291.2139 (select "1" to speak with someone.)
Once you complete the form below, we will be in touch within three business days. Please be sure to include a phone number and/or email address where you can be safely reached. Please be sure to check your voicemail and/or spam/junk mail folder (for email correspondences). If you have not heard from a member of our team within three business days of submitting this form, or if you have safety concerns, please contact us at firstname.lastname@example.org or 1.800.291.2139. You can also visit our safety planning page. Thank you!