Request of Services Form Request of Services Heading link Copy link Name First Last Service Request Form Select All Alcohol Abuse Baby Immunizations Behavioral Health Breastfeeding Child Care Clothing Counseling Dental Depression Domestic Violence Education Employment Expenses Food Food Stamps/SNAP Health Insurance Heating Assisting Homelessness Select All Housing Immigration Services Job Training Legal Services Medical Care Utilities Temp. Assist. To Need Child (TANF) Transition Assist To Fam (TAFDC) Transportation Smoking Social Security Disability (SSDI) Substance Abuse Treatment Well Child Care Referral WIC/Nutrition Other