Forms for Applicants
After printing off all pages and completing them; you MUST bring in with your application
proof of income for every member of the household for one complete month.
Incomplete applications or applications without proof of income cannot be accepted.

Type of income proof that is accepted can be: paycheck stubs, unemployment award letter, 
disability award letter, foodstamp award letter, pension statement, SSI award letters and W2 or previous years taxes.
Also, a bank statement with deposit amount can be accepted; as SSI and other forms of income are
direct deposited. Account numbers should be blacked out with a permanent marker.
No applications will be accepted without proof of income attached.
Thank you.
 

Confidential Application for Service  Broken Appointment Policy Privacy Practices Acknoledgement

 
Assistance Plan Application Additional Medications Medical History