Crisis Assistance Screener 26-27
Please answer these questions to determine your eligibility for crisis assistance.
1. Does a member of the house have a diagnosed intellectual or developmental disability?
*
Yes
No
2. Have you been in contact with other crisis agencies (Eblen, ABCCM, Catholic Charities, St. Vincent De Paul, Grace Covenent, DSS, etc)?
*
Yes
No
3. Have you been served with an eviction notice or utility shut off date?
*
Yes
No
4. Is your need related to Hurricane Helene (displacement, housing, utility, loss of income, medical)?
*
Yes
No
If you were able to answer "yes" to questions please submit your information below and a representative will call you back to discuss our application process. You will need to have ready rental ledgers, utility "shut off" notices, and/or eviction paperwork, depending on your need.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: