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Information and Referral Request Form
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Complete this form and a member of our Information & Referral staff will contact you by the next business day.
Our business hours are Monday-Friday, 8:30 a.m. – 5:00 p.m., excluding holidays.
Please DO NOT use this form to report a case of abuse, neglect or exploitation of a child, older adult, or adult living with a disability. Call the designated hotline as listed at:
Primary Phone Number (10-digit)
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Need Help With (select up to 2 services):
Finding a Job
Home Repairs/Home Accessibility
Nursing Home Care
Paying for Prescriptions
Paying for Utilities
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