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I need help
Describe your needs and challenges that could use community help.
Are you reporting for yourself or someone else? (If reporting for someone else please share their info)
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Reporting for myself
Reporting for someone else
First Name
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Last Name
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How do you like to be addressed?
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She/her
He/him
They/them
Phone number
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Type of phone
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Home
Work
Cell Phone
Other
Email
Street address
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Town
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State
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Zip code
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Please describe the help you need and why:
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Please select the categories that best fit your needs.
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Housing
Food
Transportation
Essential supplies
Fuel or utility assistance
Financial assistance
Employment assistance or training
Referral to physical or mental health services
Financial counseling
Child care/respite care
A check-in call
Pet food or care
If this is a medical or safety emergency, please call 911
If not listed, describe other needs:
Urgency of your request?
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High
Medium
Low
If we call and you do not answer, may we leave a voicemail?
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Yes
No
How did you hear about RAMAN?
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Word of Mouth
Front Porch Forum
Mailing
Referral
Online search
Other