Assistance Request | Self-Referral
Attention: By completing this form, you are requesting a staff member from Pathways Shelter for the Homeless to reach out to you in order to provide assistance of some sort. Once completed, this form is sent directly to our team of staff. One of our team members will contact you within two business days. The information you enter is completely confidential and there is no cost for this service. Please use this form only to request services for yourself or a child (under 18 years old) or adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services or by their parent or legal guardian only.