Intake form

Name *

Email address *

What type of support are you seeking?

Please select at least one option.

Mental Health Support

Emergency Housing

Legal Assistance

Health Support

Educational Scholarships

Vocational Training

Political Advocacy

Volunteer Opportunities

How did you hear about us?

What is your age?

What is your gender identity?

Do you identify as LGBTQI?

What city are you currently located in?

Are you currently facing any immediate threats or danger?

If you are seeking emergency housing, how soon do you need assistance?

Which service or services are you interested in?

Please select at least one option.

Community outreach

Mental health support

Emergency housing

SwiftLink Rainbow Foundation scholarships

Skills empowerment

Additional questions or comments