Request a Need for Chinook, Montana area.

Not in the Chinook, Montana area? Request a need for another city

www.myneighborinneed.org - Request a Need Form

Do you have an immediate need? If yes, please fill out this form and click on "Submit Application."

As soon as we receive your completed form, we will verify that the request is valid. We will then post the Immediate Need to our website in hopes that members of our local community can personally help their neighbors in need!

Important: Please read before submitting your request here

This request form is only for the Chinook, Montana area neighbors in need. If you live in another area, you can use our directory to Request a need for another area

Person Submitting Request

Name:

Phone:

E-mail:

Person Needing Assistance

*Name:

*Phone:

E-mail:

Address:

City:

Information About Assistance Needed

How soon is assistance needed?

*Describe the need:
be as specific as possible.
(Example: Neighbor in Need requests someone to shovel snow from my sidewalk.)

Are there specific items needed:
(furniture, diapers, toys, food, fuel, repairs etc...)

Approximate $$$ requested (amount):
(leave at 0 if there is no monetary obligation to this need)

*Have you ever been convicted of a Felony? Please note, we are required to check law enforcement data bases. If you have been convicted of a Felony, the ONLY need request we can post for you is for a bed!

How did you hear about us?

Statement

I hereby state and affirm that I have read all of the material on this page and I confirm that the need request that I am about to submit falls into an Approved Need Request Category.

I hereby state the above information is true to the best of my knowledge. I also realize that falsifying information will jeopardize my ability to receive help. Proof of specific need, such as a financial need, may be required. By submitting this request form you authorize www.myneighborinneed.org to verify the information provided including contacting you and/or the person in need that is listed on this request form.

I understand that I may request more than one specific need at any given time, however I agree that only one of my needs can be fulfilled until I have fulfilled someone else's need posted on this site.

I have read and agree to the terms & conditions and privacy policy.

*Note: Before submitting your application, you may want to print a copy.

Print Application

Signature of person needing assistance

Date