CLIENT SCREENING FORM

Samaritans Together of Henry County, Inc. offers financial assistance to Henry County families experiencing hardships due to unemployment, underemployment, the elderly and those living on a limited income due to disability. If you are experiencing financial hardship and need our assistance, please fill out the screening form below to help us determine if you qualify for assistance.

All qualified applicants will be contacted within 48 hours to begin the in-take process at the email address provided using this form.