I Need Help
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I Need Help
Added: 4/27/2025
First Name
First Name is required.
Last Name
Last Name is required.
Email
Email address is not valid
Email is required.
Phone
Phone is required.
Are you currently employed?
No
Yes
Are you currently employed? is required.
Are you a member of Long Hollow?
No
Yes
Are you a member of Long Hollow? is required.
Requesting assistance for the following
Utilities
Food
Mortgage/Rent
Auto
Childcare
Requesting assistance for the following is required.
Reason for need
Reason for need is required.
Amount of need
Date Needed
Date Needed is required.
Please complete the captcha.