St. Dominic Catholic Church

WASHINGTON, DC

Phone Email Facebook Flocknote Instagram

Search

Assistance Request

- This form is not accepting responses at this time.
  
  St. Dominic Church and Catholic Charities of DC
  
  We collaborate with Catholic Charities of DC to respond to requests for assistance with food, rent, or utilities.
  Complete the form and it will be submitted to Catholic Charities.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  What type of assistance are you requesting? REQUIRED Food Assistance Rent Assistance Utility Assistance Please fill out this field.
  
  What is the dollar amount of your request? REQUIRED Please fill out this field. Please enter valid data.
  
  Please describe your current situation and needs. REQUIRED Please fill out this field.
  
  Submit