211 Emergency/Domestic Abuse Request

After a natural disaster, house fire, transition from a shelter, or domestic abuse incident, PJB can help you get back on your feet by providing basic needs. Basic necessities which are part of this program include clothing, shoes, bedding, and housewares. If you need help recovering from a domestic abuse situation or other household emergency, please complete the form below. We will do our utmost to meet as many of your requests as possible. As always, this program is confidential and private. If you are uncomfortable providing any identifying information on this form, you may contact the main office directly at 508-435-6511 or pjboffice@comcast.net.

Shelter/Safe House

If you currently live in a shelter or safe house, please list the name and contact info for the shelter/safe house.

Additional Information

Adult #1

Women: please use a number size when possible. For example: “women’s 10”
Men: please specify waist x length for pants. For example: “men’s pants 36×30”

Adult #2

Women: please use a number size when possible. For example: “women’s 10”
Men: please specify waist x length for pants. For example: “men’s pants 36×30”

Adult #3

Women: please use a number size when possible. For example: “women’s 10”
Men: please specify waist x length for pants. For example: “men’s pants 36×30”

Adult #4

Women: please use a number size when possible. For example: “women’s 10”
Men: please specify waist x length for pants. For example: “men’s pants 36×30”

Child #1

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Child #2

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Child #3

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Child #4

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Child #5

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Child #6

Please specify exact sizes. For example: child shirt size 8, child pant size 10.

Demographic Information (optional)

This information is used for funding purposes only! Your answers will not impact the fulling of your order in any way (even if you choose not to complete it). The information gathered may help Project Just Because to receive grants to further benefit those in need. Thank you!
(Please select all that apply)
If you selected "other", please describe how you identify your ethnicity.

Submit

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