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Client Inquiry Form
Client Inquiry Form
Have you or a household member received services from Matthews HELP Center?
--None--
Yes
No
How many people reside in your household ?
--Gender--
Female
Male
Date of Birth MM/DD/YYYY
--Zip Code--
28079
28104
28105
28226
28270
--Primary Need--
Rent
Utilities
Rent & Utilities
Nonfinancial Assistance ONLY
--Do you need help with food or clothing?--
Food Only
Clothing Only
Both Food and Clothing
I do not need assistance with either
Date of Eviction/Disconnection:
How much do you need assistance with?
How much can you pay?
Briefly describe the situation that has caused you to seek short-term emergency assistance. What has happened out of the ordinary?
Financial plan moving forward:
I understand that this submission does not guarantee that Matthews HELP Center will be able to assist me with my request:
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Menu
Home
About Us
▼
Mission, Vision, Values
Staff
Board of Directors
Community Partners
Our Impact
Apply for
Assistance
Services
▼
Food Assistance
Clothing
Transportation
Back To School
Holiday Support
Housing and Utility Assistance
Get Involved
▼
Volunteer
Shop Back Porch Treasures
Donate
MHC Events
Email List – Join & View Archive
Backporch
Treasures
Contact Us