Inquiry Form

Section 1
Section 2
Caller's Information
Please type in the language the caller feels most comfortable speaking.
(e.g. Rental Assistance due on 10.5.19 of $1234.00)
Section 3
Referral
(Note: this is based off of there need/emergency and priority list) TIPS: Motel Voucher — to rcv a voucher show up to Samaritan House at 5pm Monday - Friday. Emergency Assistance — Rent not paid after the 15th of ea/mon. Paperwork required to be eligible. Utility assistance offered. Victim Assistance — only can be referred into the program via DA, sheriff's office, or police department. Will answer questions regarding program. Immigration — First consultation is free. Accept Walk-in appointments Tuesday/Thursdays.
Section 4
Internal Contact Information