Services Questionaire – English – Dixon Family Services

Thank you for contacting Dixon Family Services (DFS). We currently offer 3 programs:

Basic Needs Program — for low-income families with children in Dixon: assessments, goal-setting, budget counseling, employment search, application navigation for government benefits, and other activities on a case-by-case basis. Some families can qualify for a one-time financial assist with utilities and/or rent.

Pantry Program — for Dixon households experiencing food insecurity. In addition to food, we sometimes have diapers, adult diapers, school supplies, toilet paper, cleaning items and other household necessities, depending on donations received.

Information & Referrals Program — for anyone in Solano County: names and contact info for agencies providing all types of human services.

Also in our building: The WIC Program — appointments at 707-469-4555. The Food Bank distributes food in our parking lot 3 times monthly — call 707-421-9777 for days and times.

Someone will contact you the same day or the next business day. DFS is open Mon–Thurs, 10am–4pm.

About you

Your full name, exactly as it appears on your driver's license or other photo ID (required)

Email address (required)

Phone number (required)

Your age (required)

Street address (required)

City (required)

What you need

Which program(s) are you contacting us about? (choose all that apply — required)

Basic Needs (rent, utilities, budget counseling, benefits navigation)Pantry (food and household necessities)Information & Referrals (help finding other agencies)Something else

Brief description of your need, with a few related details.

Examples: If you are struggling to pay your bills, what happened to cause an unexpected decrease in your household income? If you are behind on rent or utilities, tell us the total amount you now owe. What else have you tried to solve the situation — job searching, applying for government benefits, talking with your landlord, or asking the utility company what programs they offer?

Please note: We cannot pay a bill that is not in your name, and our direct bill payments are usually one-time only.

What pantry items do you currently need?

We will confirm what we have to give when we schedule your pick-up appointment.

If you need human services we do not offer at DFS, list the services you are interested in so we can refer you to local resources.

Household

Do you have children aged 0–18 living in your home? (required)

YesNo

If yes, how many and what ages?

Are you, your spouse, or a parent (living or deceased) in the military or a veteran? (required)

YesNo

If yes, who?

Is anyone in your household a senior or a person with a disability? (required)

YesNo

If yes, who?

A few last questions

Have we been able to help you before? (required)

YesNoI'm not sure

If yes, approximately when, and in what way(s) did we help?

How did you hear about us? Did someone refer you? Who, or what organization?

Which DFS program(s) would you like more information about?

Basic Needs ProgramPantry ProgramInformation & Referrals Program

Anything else you would like us to know?

Before you send

The information I have given is true and complete to the best of my knowledge, and I agree that DFS may contact me about my request.

If you do not respond with answers, we will assume you are not interested or have determined that you do not qualify, and we will not attempt to contact you further.

Please do not include medical or highly sensitive information in this contact form unless specifically requested. If you submit your name, email address, date of birth, or other personal information through this form, we will use it to respond to your inquiry, document our communications, meet applicable legal, contractual, or funder requirements, and support our operations.