Muslim Social ServicesWaterloo Region

Request support

Tell us a little about you and what you need, and our team will follow up. Your information is kept confidential.

Who is this form for?

Referring a client from a community agency? Please use the Community Agency Referral Form. It asks for the agency details, a risk assessment and signed consent.

Open the Community Agency Referral Form

Client information

Is it safe to call? *

Choose No if a phone call could put you at risk.

Address (optional)

Helps us understand which communities we serve.

What service(s) are you requesting? *

Select all that apply — you can choose more than one.

Counselling

System Navigation / Other Support

Counselling referral

Housing — what do you need help with?

Income / Financial — what do you need help with?

Settlement — what do you need help with?

Basic Needs — what do you need help with?

Family / Community Support — what do you need help with?

Education & School Support — what do you need help with?

Other navigation support

480 Charles St E, Kitchener ON · www.msswr.org