First Name *Last Name *Email Address *Phone NumberI currently live in *McPherson CountyAnother county in KansasAnother stateNames and ages of all persons in the household.I am *experiencing domestic violence.not experiencing domestic violence.Domestic ViolenceAdvocacy and outreach services for people experiencing domestic violence is available. Please call any of the following providers: SAFE Project, 24-hour hotline: (316) 263-6000. Safe Hope: (620) 241-6615 National Domestic Violence Hotline: 1-800-799-7233 or text BEGIN to 88788 Check ALL true statements. *I am working with a Domestic Violence Advocate.It is safe for me to receive calls.It is safe for me to receive voicemails.It is safe for me to receive emails.It is safe for me if the person calling identifies themselves and the purpose of the call.What kind of assistance are you reaching out for today? *Homelessness/Risk of HomelessnessHome Repairs- Not Brush Up MacRental AssistanceOther AssistancePlease choose the option(s) that best describes your current situation. *I am currently sleeping outside, in my car, or another place not meant for people to live.I am currently staying in a hotel or motel.I am currently staying with friends/family.I have been evicted or have been served with eviction papers.OtherWhat else can you tell us about your situtation?SubmitPlease do not fill in this field.
