REGISTER NEED

www.swiftresource.com

Connect 2 Help Circle

C2HC is a web-based method of connecting people in need with those who can meet the need. There are no guarantees that Helpers can meet the needs, but it's worth a try!

An Email address and phone number is needed to connect the person in need with the Helper.

If you do not have an Email address or phone, please list the Email address and phone number of someone who can contact you.

Names and contact information are kept confidential.

Name:

Requested Date:

2/5/2012

Street:

City:

Zip:

Phone:

Email:

Name (if different from one listed above):

If you do not have the required information, please list Phone Number, Email and Name of someone who can get a message to you.

Urgency of Need:

Immediately (1-2 days)

Fairly Soon (3-14 days)

Can Wait a Little (15-30 days)

Statement of Need: Please provide more details about the need - this will be emailed to Registered Helpers

Please help us understand why this has been a challenge: Will be emailed to Registered Helpers

Is the person in need currently enrolled in the following public funded systems (check all that apply)

Tracey Warner - Northern Arizona Coordinator

Email questions to: c2hc@swiftresource.com