Call-back Request Form

Call-back Request Form

If you are unable to attend our in-person walk-in hours, you may request a confidential call back. To protect survivor safety and prevent misuse of services, we do not complete full intakes online. This form allows you to request a safe return call from a Kingdom Builders advocate. Please only submit this form for yourself. If you are in immediate danger, call 911.
Name:*

First NameLast Name
Safe Phone Number:*
Please enter a valid phone number.
Is it safe to leave a voicemail at this number?*
What is the safest time of day to call you?*

Morning (8am–12pm)Afternoon (12pm–4pm)During Walk-In HoursPlease text first before calling
Are you requesting services for yourself?*
For confidentiality and safety reasons, we can only respond to individuals seeking services for themselves. Please have the individual contact us directly.
What type of support are you seeking? (Check all that apply)

Emergency HousingTransitional HousingFinancial AssistanceAdvocacy & Safety PlanningEconomic Empowerment ProgramYouth ServicesNot Sure / I Need to Speak with Someone
Is there anything important we should know before calling?*
Kingdom Builders Family Life Center provides confidential, culturally specific services. Information submitted through this form is used solely for the purpose of returning your call.

Submitting this form does not guarantee eligibility for services.
If this is not a safe device, please consider calling us directly during business hours.
📞 719-247-8190
🕒 Walk-In Hours:

Monday, Tuesday, Thursday, Friday: 9:00–11:00 AM and 1:00–3:00 PM
Wednesday: 1:00–3:00 PM

Emergency Housing Assistance
Emergency housing assistance is provided during morning walk-in hours only (9:00 a.m. – 11:00 a.m.) on designated walk-in days.
No exceptions.
Should be Empty: