Pastoral Care Request

Are you or someone you know in need of support? Please complete the form below and someone will reach out to you as soon as possible.

First and Last Name (pronouns optional)

Please provide the first and last name of the person who needs support (and the pronouns they prefer).

Contact information for the person requesting support

Provide an email and (or) phone number. For the phone number please include any necessary extensions

I'm requesting...

Please select an option from the drop down. If you have multiple requests, don't see your request topic, or need to provide more context please use the text box.

I'm requesting cont. (optional)

Please tell us as much information as you are comfortable sharing about the situation and how we can help you. If a person has been admitted to a mental, medical, or rehabilitation facility it would help us greatly if you could provide as much detail as possible!

Who needs support?

I need support

I'm requesting support on behalf of someone else

Name and Contact Info of person completing the form (if requesting support on another person's behalf)

If you are requesting support for someone else, we may contact you first to ask some follow-up questions and to get context before reaching out to the person needing help. Please provide a way for us to communicate with you.

Is this an Emergency?

If so, one of the resources listed below may better be able to immediately provide help and support.

For medical emergencies, unsafe situations, or to report a crime text or call: 911

For mental health emergencies please call or text: 988 (Suicide and Crisis Lifeline)

For LGBTQIA+ young people experiencing a mental health emergency call:

1-866-488-7386 or Text: START to 678-678 (The Trevor Project)

Pastoral Care Request

Let's stay in touch!