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PKCC New Client Request
Your Personal Information
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Your Personal Information
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Your Personal Information
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Do you need to add additional family/household members?
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Yes
No
Additional Family Members: Photo ID and/or birth certificates are required to receive clothing, hygiene, and diapers.
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HOW CAN WE HELP YOU TODAY
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I WOULD LIKE TO REQUEST A REFERRAL
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Yes
No
Referral options
Wish Project Referral
Housing Support
Mental Health Support
Recovery/Addiction Support
Help getting an ID/Birth Certificate
Other
Is there anything else you would like to share with us?
Photo / Media Consent
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YES – I give Project Kompass permission to use photos, video, or audio of me for documentation, social media, promotions, or fundraising. No identifying information will be shared without my permission.
NO – I do not give permission for Project Kompass to take or use photos, video, or audio of me for any purpose.
Submit
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