If you are in need of assistance – including help accessing healthcare, finding food pantries, rent or utility payment, etc. – please fill out the form below.
Filling out this form means you’re asking to be connected to a service provider in your area who’s able to meet a social or medical need that you or someone in your care may have. Once completed, this form is sent to the Coordination Center in Utah and a trained information specialist will be in touch.
The information you enter is completely confidential and there is no cost for this service. Please use this form only to request services for yourself or a child (under 18 years old) or adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services or by their parent or legal guardian only.