Use this form to submit a request for assistance. This could be for a variety of reasons, and in the interest of protecting your privacy, we will not ask you to identify your needs on this form. At the bottom of the form is a question regarding your consent to be contacted by a city representative. If you do not consent, you will not be contacted. If you consent to be contacted, your needs can be discussed at that time.
Are you submitting for yourself or a neighbor? * Are you needing assistance and/or are you signing up to volunteer? (check all that apply) Relationship Status Single Married Divorced Widowed Domestic Partnership Separated Unknown
What is the resident's relationship status
Monthly Income Sources Do you have any physical limitations that prevent you from leaving the home to obtain necessary supplies? * Does anyone in your household have available transportation? Are you available to assist with other neighbors? Do you consent to being contacted by a representative from the City of Sandy Oaks? * Preferred Method of Contact NOTICE: It is illegal to forge a government document and persons may be criminally prosecuted. DISCLAIMER: Under the Texas Public Information Act, Chapter 552 of the Government Code (the “Act”), “public information” is information written, produced, collected, assembled, or maintained under a law or ordinance or in connection with the transaction of official business by a governmental body, such as the City of Sandy Oaks. While the Act provides for exceptions from disclosure of information, the City cannot guarantee or assure that information provided in response to this form is confidential and/or excepted from disclosure under the Act, and therefore any information submitted in response to this form may be considered public information under the Act and released to person(s) requesting such information. * You must check this box before submitting your form