East Baton Rouge Transitional Assistance Form

East Baton Rouge Transitional Assistance Form

Welcome to our support request page. Please complete the following Support Request Form to contact our support team. Eligibility for Covid-19 impacted persons. You will receive an answer within maximum 2 business days, for urgent matters please call us on 225-663-2320. Please complete all fields.

Have you been impacted by Covid-19?

Yes‎ No‎ Unsure‎

Organization/Recommender

Name of Client

Today's Date

DOC/Registration Number

Date of Birth

How do you self Identify?

Female‎ Male‎ Trans/Female‎ Trans/Male‎

Are you a veteran

Yes No

Branch of service:

Phone

Email address
(to which our reply will be sent)

Current Address
Please list your full street address, name, city and state where you are located.

Are you currently on probation or parole?

Yes‎ No‎

Do you have a High School Diploma or equivalent?

Yes No

Do you have a college degree or some experience?

Yes No

Are you currently employed?

Yes No Yes, but I would like to search for a new job.

Are you receiving some form of case management services?

Yes No

Do you have a mentor or life coach and support system?

Yes No

If answered yes to the above questions, please explain.

Program or Activity Need of Participant (Please check all that apply)

Housing‎ Employment‎ Mental Health‎ Emergency Assistance‎ Physical Health‎ HiSet Program‎ Substance Abuse‎ Legal‎ Counseling‎ Job Training‎ Clothing‎ Education/Literacy‎ Child Care‎ Food‎ Other‎

Please share any specific help you would like to receive.

LaCOR Email DO NOT TOUCH