In-Kind and Service Assistance Request Form
If you or your service member is in crisis, and you need intervention please call 912-712-6661 for immediate assistance.
Name of Person Contacting about the crisis or assistance
First Name
Last Name
Phone Number of Person Contacting
-
Area Code
Phone Number
What is your Relationship to person needing assistance
Parent
Spouse
Child
Friend
Referring Organization
I am the individual needing assistance
Name of Organization (If referring individual)
Leave blank if you are the Individual needing assistance
Name of Person in Crisis or in need of assistance
First Name
Last Name
Phone Number of Person in need (If different than the individual in 1)
-
Area Code
Phone Number
Location of Person
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Assistance needed
VA Benefits
Homeless
Mental Health resources
Substance addiction
Request for dedication honoring service member
Employment help
Notary services
Financial resources
Grocery/food
Clothing/hygiene items
Other
If "Other" please explain what assistance you need
Name of business Establishment if not at home of where the person in need is
Is the person in crisis armed with a weapon, or is a weapon on the premises?
Branch of Service of individual needing assistance
Army
Navy
Marine corps
Airforce
Coast guard
Space Force
Fire department
EMS
911 Dispatcher
Police/Sheriff
What assistance does the Individual need specifically
Email of individual or person referring to StrykeTeam
example@example.com
Is there any other information we need to know
Submit
Should be Empty: