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Community Navigator

Need help? Let's Connect!

Sometimes, you need a little personal touch. A warm hand and a kind ear to listen can help in many ways. If you found our Resource Page and still didn't find help, perhaps our Community Navigator can make the difference. First, be sure to scroll through all the resources on our navigation page by clicking here: RESOURCES. Then, if you are still needing assistance, complete the form below. Our Community Navigator will reach out to you as soon as possible.

Click here to try the self-service option.

Tell us how we can help

* Indicates required field

Name *

First

Last

Total number of adults in the home *

Address *

Line 1

Line 2

City

State

Zip Code

Country

First names and ages of children in the home *

Phone Number *

Is this number is capable of text messaging? *

Yes No

Email *

What types of resources are you seeking? Please check all that apply: *

Food/Grocery help Utility/Rent assistance Childcare/summer/after-school programs Homelessness resources Affordable Housing Transportation Domestic Violence Mental Health services Other (Define here)

Type "other" answers here. *

Receipt of Community Navigator services is not contingent upon answering the following optional questions; however, it may allow the Community Navigator to provide assistance that is better-tailored to you.

Age *

Disability Status *

Gender *

LGBTQIA+? *

Race/Ethnicity *

Language most spoken at home *

Veteran Status *

Are you (or your spouse) an honorably-discharged veteran of the United States Armed Forces? If so, please include branch, number of years served, and whether you/your spouse are retired from the military.

Name and Practice of your Mental Health Provider *

From which of the following entities have you received assistance in the past 12 months? Please check all that apply: *

Salvation Army Township Trustee Bauer Community Partners Area IV Energy Assistance (LIHEAP) White County Food Pantry Twin Lakes Food Pantry Food Finders REMC Energy Assistance Local Church(es) (if so, please list): None

List Churches if Applicable *

Release of Information (Required)

I authorize the White County United Way and its employees, to release ANY and all of my personal information for the purpose of assistance through the WCUW’s Community Navigator Program. I further understand and agree that this authorization shall remain in effect until and unless I withdraw it in writing.

Type your full name as consent, below. If you are submitting this form on someone else's behalf, we will seek client confirmation. *

(Optional) Additional details which may be helpful *

Submit