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Client Referral - OSB
Fill in the below form to request assistance. The information collected here remains confidential and will not be given to anyone outside of our organization.
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Preferred Language
*
English
Spanish
Other:
How do you identify?
*
Asian
Hispanic/Latino
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Black/African American
White/Caucasian
Other:
Required
What can we help with?
*
I need a case consultation regarding my DCS case
I need help finding housing or emergency shelter
I need help finding a food box for my family
I need help finding resources for bill assistance
I am looking for parenting classes or a support group
Other:
Required
Please give a short description of what you are requesting help with.
*
Your answer
How did you hear about us?
*
Google / Search Engine
Department of Child Safety (DCS)
News
Attorney
Social Media
Provider
Friend / Family
Faith Based Organization
Other:
Required
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