• Reassurance Program Application

  • Please fill each section thouroughly and to the best of your ability. You will receive an email from our Program Coordinator within 72 hours to discuss your application.

    At this time, we are only accepting applicants who reside in North Carolina. Reassurance calls are intended to be 5-10 minute check-in calls that are social and supportive in nature. The Reassurance program is not intended to replace case management, therapy, or act as suicide watch for participants.

    HopeLine does not charge a fee for this program, but does accept donations. 

    Donations can be made online HERE or checks can be mailed to

    PO Box 10490 Raleigh, NC 27605

  •  -  -
    Pick a Date
  • Emergency Contacts

    In order to be enrolled in our Reassurance Program, you must have at least two emergency contacts on file with our organization. These emergency contacts will be contacted in the event that we are unable to get in contact with you for three consecutive days.
  • Contact Person #1

  • Contact Person #2

  • Additional Contacts (Optional)

  • Should be Empty:
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