Request Assistance

BALΛNCED COLLECTIVE – Support Request

Tell us what’s going on and how we can help.

Contact Information

Full Name*

Phone Number*

Email (optional)

City / Area*

What do you need help with?

Housing Support Food Insecurity Transportation Support Mental Health Support

Housing Support Details Current housing situation Landlord / property manager name (if applicable) Amount needed or type of housing help Do you have a disconnect/eviction notice?

Food Insecurity Details

Household size

Do you have SNAP/EBT?

What kind of food help do you need?

Transportation Support Details Type of transportation needed

Date / time needed (if appointment)

Pick-up area

Mental Health Support Details Type of support Are you currently connected to a therapist or agency? Briefly describe what you’re experiencing Is this an emergency or safety concern right now?

Additional Information How urgent is this request? Anything else we should know

By submitting, you understand that BALΛNCED COLLECTIVE’s support is based on available funding and partnerships. Submission does not guarantee financial assistance.

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