Assistance Request Form/Contact Us

This is a self sufficiency program for people that Live & WORK in Brookings, please review the website to clarify if this criteria fits your situation. Otherwise visit the resource tab for other options that are a better fit for your situation. For people who "LIVE & are actively WORKING" in Brookings.

***YOU MUST FILL OUT EVERY Q & THE CAPTCHA PUZZLE OR IT WILL NOT GO THRU***

My Neighbor
Brookings, 57006

Phone: 605-691-3225

E-mail: info@myneighborbrookings.net

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Contact us by using this confidential form. We will attempt an initial response ASAP or within the week, during office hours M-F, NOT including weekends, holidays or closure. If you dont receive a response you may wish to call to check on office availabil

Please correct your input in the following fields:

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First Name: *

Last Name:(also previous names if have changed in the last 5 years) *

FULL Address(St, City, State): *

E-mail address: *

Telephone & Can you receive texts at this number? *

Best time to call you, please include break times etc. around your work schedule: *

Are you currently involved in the legal system or the courts? *

Your Date of Birth:(m/d/yy) *

Who is your landlord? name and contact info if asking for rent assistance include Landlord EMAIL:: *

Are you a student at SDSU or other student? Where? Dates of registration? area of study? *

You can also call 211, which is a Directory of Community Resources and Assistance Programs.

Please review the "Resources" tab for other organizations that could help you.

Make sure all the information is COMPLETE in DETAILS and informative, or the process will take longer to proceed.

CRISIS: Please state why it is difficult to pay this bill (s)... current circumstances: *

Amount Requested for Crisis: (list out the AMOUNT & CREDITOR in detail) *

Who lives in your Household? (Adults and children, Names and DOB for each household member)) *

Is your crisis DIRECTLY related to COVID? if so state how COVID has effected your income/job. *

ASSISTANCE: Have you asked for help or do you receive assistance from other organizations THIS PAST YEAR & WHAT DID THEY HELP WITH? (list all) *

EMPLOYMENT: (please list for each working household member) List employment history WITH DATES for the LAST YEAR. You will be required to submit your last two paystubs. *

Captcha (spam protection code) *

MY NEIGHBOR RELEASE OF INFORMATION I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact and providing service for the duration of the crisis request. I am aware that I can revoke my consent at any time and must do so in writing. I give my consent for any person, agency or institution to release and furnish information (orally or in writing to include copies of records) to the My Neighbor Program. This consent is given for use by the My Neighbor Program in administration of its benefits and resource programs to assist with the crisis request.

Note: Fields marked with * are required

Please be aware that the contents of this form are not encrypted

Contact Us

*For People that LIVE & WORK in Brookings

Remote Office

Mailing Address:

PO BOX 91

Brookings, SD 57006

Phone: +1 605 6913225 +1 605 6913225

* It is HIGHLY recommended that you complete the ONLINE request form, as this will contain a Release Authorization that needs to be in place to proceed. Otherwise a paper copy can be mailed to you... it will just take longer.

It is important to leave a message and if you have breaks during your work day please state when those are and every attempt will be made to connect with you when you are available.

E-mail: info@myneighborbrookings.net

The Process...

Our Missions is to help our commuity members who are hard working and other wise self sufficient, but are in crisis and budget difficulty when their paycheck is not enough.

Each person or family who requests help from MY NEIGHBOR starts with an INITIAL PRE-ASSESSMENT to determine the most efficient and effective way to help you in your crisis.This process typically STARTS over the phone or thru other communication sources if a phone is not available.

If it is determined that the My Neighbor program is a able to financially assist, the Requester goes through an in-depth assessment process to determine a plan of action with LONG-TERM SOLUTIONS.

Informational poster for the donor and those in need of service
My Neighbor info poster.pdf
Adobe Acrobat document [1.1 MB]

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