Request For Services Screening

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  • Request For Services Screening

    Due to a staffing transition, JFS is currently unable to process financial assistance requests. Please go to www.washtenaw.org/barrierbusters or call 211 to find an agency who can assist you at this time. If this form will not work for you, to request services please email info@jfsannarbor.org or call 734-769-0209. 
  • Which of the following apply:

  • Date of Birth*
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  • Is it okay to leave a voicemail?*
  • Do you need interpretation of phone calls/emails?

  • Demographics

    The following questions are for reporting purposes only and in no way impact eligibility for programs. Jewish Family Services provides services for all residents of Washtenaw County. We are committed to providing affordable, accessible, holistically-oriented and culturally sensitive care to our clients, whatever their identification, affiliation, lifestyle, background, race, religious creed, or national origin.
  • Immigration Status

  • Household Income per year:*

  • Source of Income (please mark all that apply):*

  • Do you have critical or urgent needs in any of the following:

  • Are you 60 years old or older?*
  • Do you have family and/or friends who you can rely on support?*
  • Do you have any concerns about your housing or home safety?*
  • Do you feel like your health needs are being addressed?*
  • Do you have difficulty remembering or concentrating on day to day activities?*
  • During the last two weeks have you been bothered by feeling down, sad, hopeless?
  • During the past two weeks have you been bothered by having little interest or pleasure in doing things?

  • Please be aware that JFS is not open 24 hours, hours of operation are Monday-Thursday 9am-5pm, Fridays 9am-3pm and is closed on holidays.  All requests will be responded to on the next business day.  If you are feeling unsafe, thinking of harming yourself or others please call 911 or head to your local emergency department.

    Additional crisis resources include: Washtenaw County Crisis Line (734) 544-3050, Crisis text number (text “HOME” to 741741), Psychiatric Emergency Services (734) 936-5900.

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