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HUMAN SERVICES AGENCY 2115 West Wardrobe Avenue, Merced, California (209) 3853000 EMERGENCY ASSISTANCE REFERRAL FORM Name of Person Making the Referral Date Telephone (209) 3853000, Extension TO:
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Start by downloading the emergency assistance referral form pdf from the designated website or source.
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Open the pdf file using a pdf reader or editor software on your computer or device.
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Read through the instructions and guidelines provided on the form to ensure a clear understanding of the information required.
04
Begin by entering your personal details such as your full name, address, contact number, and any other requested information in the designated fields.
05
Provide information about the emergency situation, including the date and time it occurred, a brief description of the incident, and any supporting documentation that may be required.
06
If applicable, provide details of the emergency assistance or services required, such as medical aid, shelter, food, or financial support.
07
If there are any witnesses to the emergency situation, provide their names and contact information to support your referral.
08
Review the information you have entered to ensure accuracy and completeness.
09
Save a copy of the completed form on your device and print out a hard copy if necessary.
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Submit the form as per the instructions provided, either by mailing it to the designated address or submitting it electronically through the specified online platform.
Who needs emergency assistance referral form pdf?
01
Individuals who have experienced a genuine emergency situation and require immediate assistance can benefit from the emergency assistance referral form pdf.
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This form is essential for individuals who may have been injured, affected by a natural disaster, facing financial hardships, or in any other circumstance requiring immediate support.
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Government agencies, nonprofit organizations, or charitable institutions often rely on the information provided in the emergency assistance referral form pdf to assess and provide necessary aid to those in need.
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What is emergency assistance referral formpdf?
Emergency assistance referral formpdf is a form used to request urgent help or support.
Who is required to file emergency assistance referral formpdf?
Any individual or organization in need of emergency assistance is required to file the form.
How to fill out emergency assistance referral formpdf?
The form can be filled out by providing relevant information about the emergency situation and the assistance required.
What is the purpose of emergency assistance referral formpdf?
The purpose of the form is to facilitate the quick and efficient provision of emergency assistance to those in need.
What information must be reported on emergency assistance referral formpdf?
Information such as the nature of the emergency, contact information, and details of the assistance required must be reported on the form.
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