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Community Information & Referral
We're here to help you 24 hours a day every day. Call 602-263-8856 from anywhere / 800-352-3792 within area codes 520 & 928.
Online Assistance Request Form
Updated July 10, 2006

For immediate help, call our 24-Hour Help Hotline

602-263-8856 from anywhere
800-352-3792 within area codes 520 & 928

If you can wait up to 10 business days for assistance, you may use the form below. We will write back to you during our administrative office hours only (8am-5pm Monday-Friday excluding holidays).

DO NOT USE THIS FORM TO SEND US SPAM OR ADVERTISING OF ANY KIND. SUCH MESSAGES WILL BE REPORTED TO THE ABUSE DEPARTMENT OF YOUR INTERNET SERVICE PROVIDER!

IF YOUR RENT, MORTGAGE OR UTILITY BILLS ARE DUE SOON, OVERDUE, OR YOU HAVE ALREADY RECEIVED AN EVICTION OR A UTILITY SHUT-OFF NOTICE, CALL US AND DO NOT USE THIS FORM!
If you use this form, chances are we will not be able to help you in time! You will be evicted and/or your utilities will be shut off!


Please provide the following information to help us serve you better:

Map of Arizona with CIR's general service area highlighted in blue.In what city within our service area is this help needed?

If you live in areas in or near Bisbee, Clifton, Nogales, Safford, Sierra Vista, or Tucson, please contact Information & Referral Services in Tucson for assistance.

Your Email Address:

Please note that characters such as "_" (underscore) in your email address may cause this form to not work. If that happens, please call us for assistance at 602-263-8856 from anywhere or 800-352-3792 within area codes 520 & 928.

Confirm Email Address:

What is your Zip Code?

How long have you lived at your current residence?

What is your age group?

What is your gender?

What is your ethnic background?

Please briefly describe the kind of assistance you need:

Please note that will be referring you to people who may help you. We do not give advice on issues including, but not limited to, legal, medical, landlord-tenant, nor do we offer direct services for case management, counseling, food, or shelter.

Do not send us any sensitive information including Social Security numbers, legal case numbers or specific court case histories. Court cases must be handled by you or your legal counsel with the court in which they were or are to be tried.

How did you hear about us?

Terms of Use: I acknowledge by checking the box to the left and clicking on Submit Request below that Community Information & Referral may take up to 10 business days to respond to my request for help.

For Immediate Help Call our 24-Hour Help Hotline

602-263-8856 from anywhere
800-352-3792 within area codes 520 & 928

If this form does not work for you, call us.


 

 
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