Connect With Us

Tell us what's going on. A real person will follow up.

Your name *

County

Best time to reach you

Phone

How would you like us to reach you?

Phone callTextEmail

Please share only what you're comfortable with. Your request will only be seen by East Texas Alliance of Hope care coordinators.

What happens after you send this

A coordinator will call, text, or email you to finish your intake. We keep client records in our secure care-management system (Pearsuite) — you don't upload documents here. When we meet, we will ask you to bring:

Photo ID / driver's license
Social Security cards (for each household member)
Pay stubs (last 3 months)
Bank statements (last 3 months)
Award or benefit letters (SNAP, SSI, VA, etc., if any)
Your lease (if you're asking about rental assistance)

Bring what applies to you. If something is missing, we'll still meet with you and help you gather it.

Consent & Release

Please read and check the boxes that apply. See our privacy summary for details on how we protect your information.

I authorize East Texas Alliance of Hope to contact me and to share the information I've provided with partner agencies, providers, and community organizations the Alliance reasonably believes may be able to help me. This includes care coordination and case-management activities. I understand I can withdraw this authorization at any time in writing. *Optional: You may include faith-based organizations and churches among the partners you contact on my behalf. (Leave unchecked and we will not share with faith-based partners.)I understand that East Texas Alliance of Hope does not guarantee any specific service, benefit, eligibility, or outcome. The Alliance coordinates connections; each partner agency makes its own decisions. I release East Texas Alliance of Hope and its staff and volunteers from any claim arising from a partner's decision or from services I choose to accept or decline. *

Type your full name to sign *

Typing your name and pressing "Send request" is your electronic signature. We'll record the date and time.

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