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Services Request Application
for Survivors & Victim Advocates

If you or someone you are supporting is in need of services, please complete the application below. A member of the Magnolia Rose team will respond as soon as possible. We are a volunteer-run organization and may not be able to reply immediately. If you are in immediate danger, please call 911. For urgent human trafficking concerns, contact the National Human Trafficking Hotline at 1-888-373-7888 or text “BEFREE” to 233733. You can also reach the Virginia State Police by dialing #77.

Request for Services

Please fill out the following form.

What is the safest way to contact you?
Email
Phone
Are you interested in services for yourself or a client?
Myself
Client
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 Magnolia Rose Cottage, Inc. | 2026

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