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 Need for Assistance Application

If you need assistance, please complete the short application below and press the "submit" button. Your information will be submitted to our staff electronically. Once your information is received, a staff member of Safe Haven will contact you in order to further evaluate your need.

Note: All information will be held in strictest confidence and will not be provided to any sources without your specific permission except as required by law.

  Please fill out fields completely
 
Name (You may use
   an alias if desired)   
 
Email address  
Mailing address  
City, State, Zip   ,  
Phone Number  
Have you been diagnosed
as  HIV/AIDS positive? 
 Have you been treated for
  HIV/AIDS? 
-  If so, by whom? 
Describe Your Need:  
 
 
  
 
 

 

 

 

 

 
Joint United Programs on AIDS
Joint United Programs on AIDS
 
"Uniting the World Against AIDS"
 
 
 
Ryan White Clinic Statistics

 Ryan White Clinic Statistics
You may be surprised at the number of AIDS/HIV cases in the Southwest Georgia area. Click the logo above to view statistics for our area.
( » » view statistics )

   
 
 
Planned Parenthood

"Kids and AIDS: A Guide
for Parents"
( questions and answers » » )

   
 
 
 
Pandemic - Facing Aids

PANDEMIC: FACING AIDS

If current trends continue, over 100 million people will have contracted HIV by the year 2010.
( view more » » )

   
 
 
 
Joint United Programs on AIDS

6 Ways To Prevent AIDS

A well-written article that discusses many ways to prevent or reduce the risk of contracting the HIV/AIDS virus.
( view article » » )

   
 
 
 
Medical News Today

New HIV Cases Increasing In Germany, Institute Says


Calling For A Major Shift In HIV Prevention Priorities


Visit www.medicalnewstoday.com for complete medical news.
 
 
 
Medical News Today

Get the facts about HIV/AIDS

HIV/AIDS Prevention