A few questions about your needs. Answer what you can. You can skip these questions and still send your request. You do not need to have applied for other assistance first.
Food Have you applied for SNAP (food stamps)? (optional) Choose an answer or skip Receiving assistance Applied and waiting Applied but not currently receiving assistance Haven’t applied Would like help applying Not sure Prefer not to answer
Have you connected with a food pantry or food bank? (optional) Choose an answer or skip Yes No Would like help finding one Not sure
What food support would help? (optional) Choose an answer or skip Groceries Prepared meals Baby formula or infant food Help applying for benefits Something else
Housing or shelter What kind of housing help do you need? (optional) Choose an answer or skip Somewhere to stay Finding housing Deposit or moving costs Staying in current housing Something else
Have you contacted a shelter, housing program, or caseworker? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Is there a date you need housing by? (optional)
Childcare Have you applied for the Idaho Child Care Program (ICCP)? (optional) Choose an answer or skip Receiving assistance Applied and waiting Applied but not currently receiving assistance Haven’t applied Would like help applying Not sure Prefer not to answer
Have you contacted childcare providers or other assistance programs? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
What is the main childcare need? (optional) Choose an answer or skip Finding a provider Paying for care Before or after school Different hours or temporary care Something else
Transportation What do you need transportation for? (optional) Choose an answer or skip Appointments Work or job search Groceries or basic needs School or childcare Something else
Have you contacted a ride service, transit program, or another assistance program? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Have you contacted the St. Vincent de Paul Helpline for transportation help? (optional) Choose an answer or skip Received help Contacted and waiting Contacted but haven’t received help Haven’t contacted them Would like help connecting Not sure Prefer not to answer
Do you need an accessible vehicle or another transportation accommodation? (optional) Choose an answer or skip Yes No Not sure Prefer not to answer
Medical or healthcare What kind of healthcare help are you looking for? (optional) Choose an answer or skip Finding a clinic or provider Insurance or Medicaid application Prescriptions Medical bills Dental or vision care Something else
Do you have Medicaid, or have you applied? (optional) Choose an answer or skip Receiving assistance Applied and waiting Applied but not currently receiving assistance Haven’t applied Would like help applying Not sure Prefer not to answer
Have you contacted a clinic or another healthcare assistance program? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Mental health or counseling What mental health support would help? (optional) Choose an answer or skip Finding counseling Paying for counseling Finding someone who accepts my coverage Peer or support groups Help connecting with services Something else
Do you have Medicaid, or have you applied? (optional) Choose an answer or skip Receiving assistance Applied and waiting Applied but not currently receiving assistance Haven’t applied Would like help applying Not sure Prefer not to answer
Have you contacted a counselor, provider, or support program? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Employment What employment help do you need? (optional) Choose an answer or skip Job leads Resume or applications Interview preparation Training or education Support keeping a job Something else
Have you connected with a job center or employment program? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Is there a practical barrier you would like help with? (optional) Choose an answer or skip Transportation Childcare Clothing or equipment Internet or computer access Something else Prefer not to answer
Rent or utilities Which bills do you need help with? (optional) Choose an answer or skip Rent Utilities Both
Have you received a written eviction notice or court summons? (optional) Choose an answer or skip Eviction notice Court summons Both Neither Not sure Prefer not to answer
What is the eviction notice or court date? (optional)
Have you contacted Jesse Tree for rent assistance? (optional) Choose an answer or skip Received help Contacted and waiting Contacted but haven’t received help Haven’t contacted them Would like help connecting Not sure Prefer not to answer
Have you received a utility shut-off notice? (optional) Choose an answer or skip Yes No Service is already disconnected Not sure Prefer not to answer
What is the shut-off date? (optional)
Have you applied for LIHEAP (home energy assistance)? (optional) Choose an answer or skip Receiving assistance Applied and waiting Applied but not currently receiving assistance Haven’t applied Would like help applying Not sure Prefer not to answer
Have you contacted The Salvation Army about Project Share energy assistance? (optional) Choose an answer or skip Received help Contacted and waiting Contacted but haven’t received help Haven’t contacted them Would like help connecting Not sure Prefer not to answer
Have you contacted your utility company about payment arrangements? (optional) Choose an answer or skip Yes No Would like help Not sure
Have you contacted the St. Vincent de Paul Helpline for this need? (optional) Choose an answer or skip Received help Contacted and waiting Contacted but haven’t received help Haven’t contacted them Would like help connecting Not sure Prefer not to answer
Have you applied anywhere else for rent or utility assistance? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Which other programs have you tried, if you would like to share? (optional)
Domestic violence support What support would you like help finding? (optional) Choose an answer or skip A confidential advocate Safer housing Legal resources Financial or practical support Something else Prefer not to answer
Have you connected with an advocate or support organization? (optional) Choose an answer or skip Yes No Would like help connecting Prefer not to answer
Is the contact method you enter below safe for us to use? (optional) Choose an answer or skip Yes Only at certain times I need another contact method Please do not contact me yet
Safe contact instructions (optional)
Legal help What kind of legal resource are you looking for? (optional) Choose an answer or skip Housing Family matters Benefits Employment Consumer or debt matters Something else Prefer not to answer
Have you contacted legal aid, a lawyer, or a legal clinic? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Is there a legal deadline you want us to know about? (optional)
Something else What kind of support are you looking for? (optional)
Have you contacted or applied with any organizations for this need? (optional) Choose an answer or skip Connected already Contacted and waiting Haven’t contacted anyone Would like help connecting Not sure Prefer not to answer
Which organizations, if you would like to share? (optional)
