Assistance Request Form

If you are experiencing an urgent need related to COVID-19, dial 2-1-1 or 888-892-1162 (available 24 hours a day 7 days a week) to contact NC 2-1-1 by United Way of North Carolina for assistance.

If you are experience an urgent need unrelated to COVID-19 and you would like to be connected to services near you, please complete the form below and an NCCARE360 Navigator from NC 2-1-1 will contact you. The information you enter is completely confidential and will only be shared in order to connect you to services.

Please use this form only to request services for yourself, or a child (under 18 years old) or adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services, or signed by their parent or legal guardian only.