How can we help?

Please fill out this form and click submit.

Compassion Hotline (Addiction Recovery/Assistance) (601) 721-4483

Our desire is to bring hope and change to the hopless through the power of Jesus Christ. We all find our selves in seasons of hopelessness if we can help you please let us know and we will do our best to walk with you through your current season. If you need imediate medical assistance please call emergency services at 911

Date:

*

Name

*

Age

*

Gender

*

Please select one option.

Male Female

Phone

*

Address

*

Email

This address will receive a confirmation email

Description of need.

*

Please select one option.

Drug Rehabilitation Mental Health Care Counseling Someone to talk to or pray with Financial Assistance Physical Help Construction Other

If other please describe

*

Have you applied for this need with any other church or agency please list below

Description

Please fill out this form and click submit.

Please Fix the Following

Close