Better Together!

After filling out this form, please inform the person to reach out to us at (605) 331-3935. Have them tell us that you referred them to us. We will reach out to you to confirm any questions we may have & then reach out to them to schedule an appointment within 24-48 hours of them calling us.

Thank you for caring & for taking the time to reach out!

Name of person in need of assistance

First Name

Last Name

Phone

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Church Partner

Name of Church Contact Person

First Name

Last Name

Phone Number of Church Contact Person

(###)

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Email of Church Contact Person

Brief description of need/situation

Brief description of their relationship with your church.

(Are they a member? regular attender? Person the church has helped in the past? You don't know them at all...)