ApplIcation

All applications for assistance are subject to availability of funds and eligibility verification. Please review the complete listing of eligibility requirements here before completing an application.

*Assistance will be provided to qualified applicants on a first come, first served basis determined by receipt of completed application form and all supporting documentation.

*Applicants must provide all required supporting documentation to be considered eligible for assistance; in-person or postal mail submission options can significantly delay assistance or potentially result in ineligibility if funds become unavailable during the verification/approval process.

*For technical assistance with completing the application form please email mgraybill@communitycares5.org or jaeshaffer@communitycares5.org 

*To request a paper application be mailed to you please submit a request using the Contact Us form