General Assistance Inquiry

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Completing this form does not guarantee financial support.

* Indicates required question

Email

First & Last Name

Phone

Are you currently employed? *

Yes

No

Are you an Otsego County resident? *

Yes

No

What type of services are you in need of? (Check all that apply)

Food Assitance

Childcare

Medical Transportation

Clothing

Experienced an emergency

Other

If you have experienced an emergency please list type (i.e. house fire, etc) and date of emergency)

If other, please explain

Have you applied and/or received any other assistance related to this need? *

Yes

No

If yes, what organization and what type of assistance was received?

How many individuals are in your household? (Children and adults)

Your inquiry was submitted.

116 E 5th St, Gaylord, MI 49735

Hours | Mon - Fri, 9am - 4pm

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