Request Assistance – PeopleCorp

You are not alone. All information is kept strictly confidential. A PeopleCorp coordinator will reach out to you within 48 hours after reviewing your request.

Personal Information

First Name *

Please enter your first name.

Last Name *

Please enter your last name.

Email Address

Optional, but helpful for updates

Phone Number *

Please enter a phone number.

Your Address

Street Address *

Please enter your street address.

Town / City *

Please enter your town.

State

How Did You Find Us? This helps us understand our community and, if needed, verify requests.

How did you hear about PeopleCorp?

Reference Name

A neighbor, pastor, doctor, or community member

Reference Phone or Email

Nature of Your Need

What type of help do you need? * (Select all that apply)

Skilled Trades

Plumbing, electrical, carpentry, minor repairs

Transportation

Ride to doctor, pharmacy, appointments

Groceries or Utilities

Help obtaining food, medicine, or essential items

Counseling or Visitation

Companionship, emotional support, regular check-ins

Organizing or Cleaning

Help sorting, decluttering, light housekeeping

Specific Item Needed

A particular object or resource you need

Please select at least one type of need.

Please Briefly Describe Your Need *

Please describe your need.

❤ Give Back in Your Own Way

Many of the people we serve find it meaningful to give back in their own way — not as a condition of receiving help, but because community works best when everyone contributes what they can. Is there anything you might be able to offer, even something small? A phone call to check on a neighbor, a skill or craft you enjoy, help with a simple errand, or just a listening ear?

Is there anything you might be able to offer?

Completely optional — no pressure at all. Every contribution, no matter how small, matters.

Your privacy matters to us. Information shared here is only used to coordinate assistance. We are a faith-based organization committed to dignity and confidentiality.

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Review Your Request

Please review the information below before submitting. You can go back to make changes.

Personal Information

Name

Phone

Address

Street

Town / State

How You Found Us

Referred By

Reference

Request Details

Help Needed

Description

❤ Give Back in Your Own Way

Your Request Has Been Received

Thank you for reaching out. A PeopleCorp coordinator will review your request and contact you within 48 hours.

A confirmation has been sent to the email addresses on file.

REF-#000000

Please save this reference number for your records.

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