For your protection, the protection of our Good Samaritans and to maintain the integrity of this program we must do our best to insure your needs are in fact genuine. Please help us to help you by filling out the Benevolence Application located here and emailing it with the link located on the form as well as this quick notification of you need located below. Your personal information will be held in the strictest confidence and not available to the public in anyway whatsoever. The only information provided in our public database will be an anonymous number with a description of your need. When a Good Samaritan is able to help they will contact us using the anonymous number once we have validated the Samaritan's ability to help will will facilitate a private meeting between you and the person who can provide you the help you have requested.

Email Address::

First Name::

Last Name::

Address::

Phone Number::

Category of Need::

Please describe your need in as much detail as you can::

The Good Samaritan Network

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