Tangible Resources Request Form

* Name of Individual Requesting Resources:

* County of Residence:

* Date of Birth

* Phone Number:

* What type of reentry support or resources are you in need of:

* Email:

* Please provide a statement about your circumstances and your need for reentry support and/or resources:

* How would this reentry support and/or resource help you:

* Have you ever received funding from GRASP?

* Emergency Contact: (Please list name and number for a family member or close friend) *note- if your applying for a loved one, please list your name and contact information here.

* Where do you currently reside?

* Any additional information you'd like to share:

* Name of person filling out form: (Your name) *note- if your requesting assistance for a loved one, please list your relation to this individual.

By giving us your phone number and email address, you are giving GRASP permission to contact you via email, phone, or text.