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Assistance form
If you would like to start the process of asking for general help from HHD or to start the process of asking for housing help from HHD please fill up this form.
* Indicates required question
Email
*
Your email
Full name
*
Your answer
Physical address
*
Your answer
County and Zip code
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
How old are you?
*
Your answer
What kind of assistance do you need?
*
Education
Career Opportunities
Transportation
General support
Independent living
Community development . want to buy a house
Other:
Required
Are you deaf of hard hearing?
*
Yes I am deaf
No
I am applying on behalf of someone
Which country are you from?
*
United Stated
Outside United States
Please specify the State you are from.
Your answer
Please specify city
Your answer
Please specify county
Your answer
If you are from another country, please specify the country you are from.
Your answer
Ethnicity
*
Hispanic
Asian
African-American
African
Pacific-Highlander
Caribbean
White
American Indian
Other
Gender
*
Gender
Male
Female
Non-binary
How did you heard about us?
*
Family member
Friend, my friend referred me to this
Social Media
Church
Co-worker
Neighbor
Submit
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