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Thanks for taking a moment to let us know how you're doing!
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Indicates required field
Client First and Last Name
*
Client may also be known as:
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Your name, if different from Client:
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Phone Number of Person Completing the Form
*
DO NOT list client's phone number here, unless you are the client.
Type of update:
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New need
Status update
Details to add to client record
Other
What new information should we know about this client? (Note: if the client does not have an established history with WCUW, please complete the intake form on the previous page.
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WCUW reserves the right to share this updated information with others in order to best serve the client. Please be aware that while we protect privacy whenever possible, your release of information here provides us consent to discuss your case with other human service agencies who may serve you.
What should we do next with this informaiton?
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Contact the client
Keep information for your records; no response needed
Inform other service providers
Begin a new case or investigation
Contact the proper agencies
Prepare for someone to reach out to you
Submit
home
Who We Are
Board of Trustees
Volunteers
Equity
Contact Us
What We Do
Programs & Initiatives
>
Winter Programs
CAP
White County Cares
UCO
>
Teen Cafes
recovery
AmeriCorps Blog
Workplace Resources
JR Board
Grantmaking
>
Become a Partner
Reports
>
ALICE
Events
>
trivia
Insight Symposium
Duck Race
Family Break Nights
Get Help
Intake Form
recovery
support groups
Resources
>
families & Children
>
Winter Programs
Parents Night Out
Boys and Girls Club
Girl Scouts Central Indiana
Sagamore Boy Scouts
Council on Aging and Public Transit
Housing & Utilities
>
Area IV
Energy Assistance
HUD Section 8
Homeless Services
YWCA DVIPP
Nutrition & Healthcare
>
Family Health Clinics
Food Finders
WCFoodPantry
Education & Workplace
>
Literacy Volunteers
Workplace Resources
Donate
