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COMMUNITY RESOURCES

Community Resources

Catholic Charities North Dakota

Community Resource Assistance

Request Form

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Are you experiencing some hardship and need some help getting back on your feet? Catholic Charities North Dakota is here to help assist in pointing you in the right direction Our Community Resource Coordinator can provide assistance and referrals if you have needs we aren’t able to help with.

If you need assistance, please fill out the form below and allow for 1 to 2 business days for our Community Resource Coordinator to respond.

Name*

Phone*

Address, City*

Gender*

Age*

Are You Currently Employed?*

Yes

No

Type of Employment/Hours Worked

Does Anyone Else Over 18 Live in Your Household?*

Yes

No

Does This Person Work?

Yes

No

Type of Employment/Hours Worked

Is Anyone in Your Household Over the Age of 65 or Have a Qualifying Disability?*

Yes

No

Estimate of Total Household Income*

Do You Have Children?*

Yes

No

Do They Live With You?

Yes

No

How Many/Ages?

What Are the Three Top Needs of Your Household?* (Multiple Choice with limit of 3 options selected)

Gasoline

Clothing

Baby Items

Cell or Phone Bill

Food

Household or Personal Supplies

Furniture

Domestic Violence

Legal Help

Medical Expenses

Rent

Local Transportation

Utilities

Housing

Other Unique Need

How Did You Hear About CCND? (Multiple Choice Limit of 1)

Church

Phone Book

County Social Services

Internet Search

Previous Client

Friend/Family Member

Human Service Center

Other

Have You or Anyone in Your Household Received Financial or Other Assistance From CCND Within the Past Year?

Yes

No

Who and When?

Have You Contacted Other Agencies to Assist You, Such as Government or Other Businesses? Agencies?

Yes

No

What Agencies?

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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Learn More About

Catholic Charities North Dakota

Located in Fargo, Bismark, Grand Forks, and Minot, ND. Catholic Charities North Dakota specializes in adoption services and guardianship facilitiation. Serving North Dakota since 1923. Available for emergencies. COA accredited. Call today.

Fargo, ND

,

(701) 235-4457

Location Details

Bismarck, ND

600 S. 2nd St.,

Suite 150

Bismarck, ND 58504

(701) 255-1793

Location Details

Grand Forks, ND

311 4th St. S,

Suite 105

Grand Forks, ND 58201

(701) 775-4196

Location Details

Minot, ND

216 S. Broadway,

Suite 202

Minot, ND 58701

(701) 852-2854

Location Details

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