2026 HELPIS Needs Request Form

Please fill in all the necessary information with as much detail as possible and we will try to accommodate your request as soon as we can.

• Please submit separate form requests for multiple individual/family requests. 

• We will be in touch within a couple of days with any questions or to confirm that we are working on your request.  

• In most cases, we require requestors to pick up. Please let us know if you this is not possible. 

HELPIS Referral Eligibility Notice

HELPIS fulfills needs requests through trusted community partners and professionals who are working on behalf of individuals and families they serve.

To ensure requests are appropriate, equitable, and connected to broader support services, this form should only be completed by someone submitting on behalf of another person or family through a professional or organizational role, such as:

• Social workers

• Teachers and school staff

• Guidance counselors

• Case managers

• Law enforcement and victim advocates

• Healthcare professionals

• Shelter and housing staff

• Nonprofit and social service agencies

• Faith-based outreach leaders

• Community resource coordinators

At this time, we are not able to accept direct self-referrals from individuals requesting support for themselves.

If you are seeking help personally, we encourage you to connect with a local school, social service agency, community organization, or trusted professional who can submit a request on your behalf.

Please note: HELPIS accepts requests only from professionals, agencies, or trusted community partners working on behalf of others.