• Need Assistance Form

  • Welcome!

    Love In the Name of Christ (Love INC) connects local churches and community resources to help meet the needs of individuals living in Staunton, Waynesboro, and Augusta County.

    Our goal is to assist you and help point you in the right direction toward resources and relationships that can help.

    Please share a few details below. After you submit this form, someone from our Connection Center will contact you to schedule a phone conversation.

  • About You

  • Date*
     - -
  • Date of Birth*
     - -
  • Do you give us permission to text you?*
  • Are you a resident of Staunton, Waynesboro, or Augusta County, Virginia?*

  • Where are you staying right now?

  • If you live outside of Staunton, Waynesboro, or Augusta County, we encourage you to connect with a local ministry in your community and/or dial 211 for assistance finding nearby resources.

    If you live within our service area, you can also explore our Community Resource Directory or visit the Augusta County Library’s Essential Community Resources page for additional local services and support.

  • Do you have your own place to live right now?(Note: a hotel, shelter, car, or staying temporarily with someone else is not counted as your own place.)*
  • Current Housing*
  • Are you currently living in the residence for which you are requesting needs?*

  • Demographic Information

    The following questions help us understand who we are serving and ensure equitable access to our ministries. Your responses are optional and confidential.
  • Gender*
  • Race/Ethnicity*
  • Relationship Status*

  • Who lives with you?

    Do not include yourself.
    • 1st Person 
    • 2nd Person 
    • 3rd Person 
    • 4th Person 
    • 5th Person 
    • 6th Person 
    • 7th Person 
    • 8th Person 

  • What You Need Assistance With

  • What do you need assistance with right now?*
  • Have you gotten assistance from Love INC before?*

  • Scheduling Preferences

    This helps us find a time that works best for your phone conversation.
  • What days usually work best for you? Select all that apply.
  • What time of day works best for you?

  • References

    We ask everyone for a few references just to help us get a better picture of their situation and make sure we’re serving well. You may submit this form without filling out your references, but we will not be able to schedule an interview with you without references.

  • Closing Questions

  • Permissions & Submit

  • Should be Empty: