Banks Construction - Employee Support Program Webform

Thrive@Work

Thrive@Work™ through Banks Construction

Trident United Way is here to help connect you to resources and support. Please complete this form to the best of your ability. Your responses are confidential and will only be used to match you with the right services. Our Intake Specialists will contact you to guide you through the next steps.

First Name

Last Name

Banks Employee ID Number

Date of Birth

ZIP Code

County

Please provide your preferred email (if no email address, please type "N/A":

Please provide your preferred phone number:

Please choose your preferred contact method

What time of day are you available to be contacted? Please check all that apply.

Morning

Afternoon

Evening

Do you have any school-aged children living at home?

Is anyone in your household age 65 or older?

What school does your child currently attend? If you have more than one child, please list all schools your child attends.

Do you have a military or service affiliation?

Active Duty Service Member

Military Spouse/Dependent

Surviving Spouse

Veteran

None of the above

	How can we help you today? (Choose all that apply)
Housing (rental assistance, utilities, housing repairs, mortgage assistance, eviction, shelter, homelessness)	Housing (rental assistance, utilities, housing repairs, mortgage assistance, eviction, shelter, homelessness)
Transportation (car payments and insurance, car repairs, bus tickets, driver’s education, gas, ride-sharing)	Transportation (car payments and insurance, car repairs, bus tickets, driver’s education, gas, ride-sharing)
Food (food pantries, baby food, application assistance for SNAP and/or WIC, nutritional assistance)	Food (food pantries, baby food, application assistance for SNAP and/or WIC, nutritional assistance)
(medical and prescription bills, dental appointments, free clinics, urgent care, health screenings, counseling and mental health services, substance abuse treatment)	(medical and prescription bills, dental appointments, free clinics, urgent care, health screenings, counseling and mental health services, substance abuse treatment)
Child Care (child care subsidies, after school programs, school supplies, developmental screenings)	Child Care (child care subsidies, after school programs, school supplies, developmental screenings)
Disaster (disaster relief, disaster recovery, disaster shelter, disaster preparedness)	Disaster (disaster relief, disaster recovery, disaster shelter, disaster preparedness)
(immigration legal assistance, eviction prevention, elder law, family law, discrimination legal assistance, heirs property)	(immigration legal assistance, eviction prevention, elder law, family law, discrimination legal assistance, heirs property)
Legal Aid	Legal Aid
Financial Literacy (budgeting courses, debt reduction, asset building, banking assistance)	Financial Literacy (budgeting courses, debt reduction, asset building, banking assistance)
Hygiene (clothing, diapers, shower)	Hygiene (clothing, diapers, shower)
Other	Other

Please provide any other details on how we can best support you.

Thrive@Work™ through Banks Construction

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