Intake

482 Collective | Pre-Intake

Sometimes asking for help is
the bravest move you can make

Need help?

We support women, children and individuals from marginalized communities who have fled intimate partner/domestic violence, sexual assault, physical/emotional abuse, human trafficking – and who are struggling with poverty and/or homelessness.

Please fill out one of the pre-intake forms below and we will be in touch within 5 days. If you are in crisis and require immediate assistance, please call 911.

Please note: We CANNOT accept referrals made by family or friends. The person in need must contact us directly (PINK FORM below) or through a case manager/crisis worker/police officer (GREY FORM below)

Pre-Intake Form
Self Referral

* Indicates required field

Name *

First

Last

Email *

Is it safe to send an email message identifying the 482 Collective? *

Phone Number *

Is it safe to leave a voicemail message identifying the 482 Collective? *

Select One *

How did you hear about us? Please include the name of the organization that referred you. *

Comment *

Submit

Pre-Intake Form
Case Manager/Crisis Worker/Police Officer

* Indicates required field

Your name *

First

Last

Your email *

Name of referring organization *

Your client's name *

First

Last

Your client's email *

Your client's phone number *

Select One *

Comment *

Submit

What to expect after you submit a pre-intake form:

We will respond by phone or email within 5 business days to set up an intake
The intake process will take approximately 15-25 minutes
We create a very safe space for you during our intake process. We have a series of well-thought out questions we will be asking you in this intake. If at any point you feel triggered by our questions, we will pause the intake and wait for you to book a follow up session when you are ready to begin from where we left off.
If you qualify for our services, we will require government issued photo identification
As of Jan 1, 2022 we will require a copy of bank statements from the past 90 days

We recognize the courage it takes to reach out for help and, if we cannot directly help you ourselves, we will make every effort to provide you with additional referral resources.

image: umitbus

482 Collective | Pre-Intake​

​Sometimes asking for help is​the bravest move you can make

Need help?

​Pre-Intake FormSelf Referral

Pre-Intake FormCase Manager/Crisis Worker/Police Officer

482 Collective | Pre-Intake

Sometimes asking for help is
the bravest move you can make

Pre-Intake Form
Self Referral

Pre-Intake Form
Case Manager/Crisis Worker/Police Officer