Apply for Assistance

This form can be used to request a variety of services through community-based organizations. All information entered into the form will be submitted to a representative at Healthy Wise County. From there, we will send a referral to a community-based organization to address the need. Healthy Wise County does not provide services directly but is an access point for Unite Us, a network of like-minded, accountable organizations dedicated to supporting the health and well-being of Wise County residents.