Please enable JavaScript in your browser to complete this form. – Step 1 of 5HOW YOUR INFORMATION IS USED Any and all information you submit to OurPath is used only to provide you with support and/or resources. As part of our mission, we also compile general data about our constituents to help us understand who seeks our services. This information does not identify individuals – only their statistics. We do not and never will share your information with any outside person or agency without your express consent. Our support team consists of volunteers who strive to respond to all requests within 48 hours. If you don’t see a response after 72 hours from submitting your request, please check your junk/spam folder.Name *FirstLastEmail *CIty *Country *United StatesCanadaOtherOther CountryOther Province/RegionStateSELECTAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPlease make a selection.ProvinceSELECTAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPlease make a selection.Postal Code *NextAre you open to giving us your phone number? This isn’t a requirement, but it may help us connect with you faster since emails can bounce to spam folders. If so, please check all permissions that apply and enter your phone number in the field that will appear below. If you do not want to give permission for OurPath to contact you by phone, leave these blank and continue.OurPath is allowed to contact me by phone.YesOurPath is allowed to contact me by voicemail.YesOurPath is allowed to contact me by text.YesPhoneNextYou are *MaleFemaleYour current relationship statusMarriedLiving Together/Domestic PartnershipSeparatedDivorcingDivorcedEngagedDatingYour spouse/partner identifies as (or you suspect is):GayLesbianBisexualAsexualTransgenderOtherNot SurePreviousNextTell us more about your situation and what you're experiencing.PreviousNextPlease help us improve our outreach efforts by telling us how you found out about our organization. You may check more than one.Internet SearchArticle/NewsBookPodcastFacebookYouTubeMediumInstagramTwitterOtherBriefly describe the source(s) you checked. Some examples: the search words you used, name of the news outlet, publication, book or podcast etc.Sign up to receive news and updates delivered to your inbox.YesPreviousSend