Get Help - U Matter 2

Confidential Intake Application

Please complete the details below to request assistance. A representative from U Matter 2 will review your submission and contact you directly.

If you are in crisis, dial 988 and press 1, or call 800-273-8255 for the Veteran’s Crisis Line.

Name *

Date *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal code

Phone *

Email Address *

Are you a veteran or the spouse of a veteran? *YesNo

How many people are living with you? *

List the names of everyone living with you and your relationship to them (i.e. Jane Doe – Mother, and click ENTER after each name). *

Are any members of the household employed? *YesNo

What is your monthly NET income? (Include employment, SSI, SS, VA, child support, etc.) *

What is the monthly NET income of the entire household? (Include employment, SSI, SS, VA, child support, etc.) *

What is your monthly mortgage / rent payment? *

Which of the following do you pay monthly (Check all that apply). *Rent / MortgageElectric / GasPhoneInternetCarCar InsuranceMedications

Please list extraordinary expenses (such as medical bills, car or household repairs, legal fees, etc.) *

Please list any and all financial aid you are receiving from VA, County, City, State, or Federal Agencies. *

Briefly describe what kind of support you are seeking. *

Please type your full name. (Your typed name serves as a signature) *

Today's Date *

Upload a pdf or image of your DD-214. *

No file chosen