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APPLICATION FOR ASSISTANCE

Any information collected on this website will only be used to determine eligibility of resources. Your information will be kept confidential and will not be shared with any outside agencies or companies. This is a nonprofit organization that only seeks to help those individuals in need find access to care and resources available for those encountering mental health challenges. 

Is this a one-time request or will you need continual assistance?

Thanks for submitting! We will review your application and a representative will respond to you as soon as possible.

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