All fields are required fields.
Agency or Organization (if not applicable, type NA)
Phone Number w/ Area Code
Numbers only - no dashes, spaces or special characters
Cell - No Text
Cell - With Text
Retype your Email Address
If this is an emergency, call 9-1-1 and get to a safe place.
Topic of Contact
I need help
I need a referral
Information about Abuse & Trauma
Information about Empower House Sponsorships
Information about Empower House
Request Investigative Services
Other / Something Else