OYDSA Assistance Request

If your organization can benefit from our services or resources, fill out and submit this form.  We will contact you.  Alternatively, you can download this form and FAX or mail it to us.  Our FAX number and address are here.  Due to the large amount of requests submitted to the OYDSA, at this time we are only able to assess and potentially grant funding for issues that directly affect safety of youth. Anything beyond a direct safety necessity, although important, will be deemed secondary for funding status by the OYDSA. If this is the case; please send a digital photo and a description via E-mail of the safety issue to the OYDSA and they will continue to be handled in the order in which they were received.

  • Please provide the following contact information:

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State
    Zip
    Organization Phone
    Personal Phone
    FAX
    E-mail

    Address of work site:

    Specific need:
    Assistance requested: