General Assistance Request

The General Assistance Request is an internal report delivered to the staff of the Joint Resilience Director. The GAR is a place to request assistance for yourself (Guard member) or your family who is struggling with any type of wellness issue.
Please fill out this form as completely as you can, but if you don’t know or are not comfortable you do not have to answer.
A member of the staff will attempt to make contact, gather further information, and provide referrals for the issues identified within a business day.

If this is an emergency, please dial 9-1-1 or get the individual to the nearest emergency room. For mental health crisis, please dial the 24/7 National Suicide and Crisis Lifeline at 9-8-8, press 1, if you are a Service Member or Veteran.

Your Name

First

Last

Your Contact Information

Your Relationship To The Person Needing Help

The Person Needing Assistance Is Aware That I Have Completed This Form

Yes
No

I want to remain anonymous (you may be contacted by staff to gather more info, but the person receiving help will not be told who completed the request)

Submit anonymously

General Assistance Request

Information about the Person completing this Form

Information about the Person needing Assistance