Intake Application

Intake Application

“Healing takes time, and asking for help is a courageous step.”- Mariska Hargitay

Are you a survivor in need of assistance? If so, we’re here to help. Please fill out the form below and a member of our team will contact you following the review of your application.  Note:  G.R.O.W. Foundation is a 501(c)3 non-profit agency providing services and/or resource referrals for (Hampton Roads) Virginia and (Burlington County) New Jersey. 

*We are currently at client capacity and unfortunately, unable to process new intake applications at this this time. Intake applications received after 11/15/21 will be placed on our waiting list until further notice and will be processed in order of receipt as openings become available. If you are in need of assistance, please visit our resource page for a list of community partners or the National Domestic Violence Hotline at www.thehotline.org for a list of national resources. Thank you in advance for your patience and understanding as we work to provide support and hope to survivors and their families.*