Berkeley Client Contact Form | Trident United Way

Welcome to the Berkeley Center for Strong Families

Thank you for visiting the BCSF. If you are here on a day when our team is not available, please complete this form to tell us more about your needs.

A member of our team will review your information and follow up within 5 business days.
If you need immediate assistance, please call (843) 761-6033.

Please note: Completing this form does not guarantee services but helps us better understand your needs so we can connect you to appropriate resources.
We’re here to help.

First Name

Last Name

Date of Birth

What ZIP code do you live in?

Please provide your county of residence

How would you like to be contacted?

Please provide your email:

Please provide your phone number:

After reviewing your request, a representative from Trident United Way will contact you within 72 hours, as close as possible to your preferred days and times, using your chosen method of contact.

	How can we help you today? (Choose all that apply)
Food (emergency box, hot meal, SNAP)	Food (emergency box, hot meal, SNAP)
Health (medical bills, Medicaid)	Health (medical bills, Medicaid)
Transportation (car repairs, gas, bus tickets, drivers' education classes)	Transportation (car repairs, gas, bus tickets, drivers' education classes)
Child Care	Child Care
Other	Other

Please describe:

How has this temporary hardship affected your budget

1 - Not at all

2 - Very little

3 - Neutral

4 - Somewhat

5 - A lot

Please provide any additional information you would like the client navigator to know before they contact you, including the amount of financial assistance you are requesting.

How did you hear about us?