Apply for Assistance


The purpose of Five County Community Action Assistance is to assist low-income individuals in becoming stabilized and work towards self-sufficiency. Assistance should also be sought when all other resources have been exhausted. Most assistance will also require clients to fall below the 125% federal poverty guidelines.



To access direct Five County services, click 2018 Community Action Application  to print application

It should include all household members (even if living with friends and family). Income verification is required for all household members over 18. Income should be verified through the following methods:

  • Last 30 days of earned income
  • Last 30 days of bank statement
  • Benefit letters (SSDI / SSI)
  • W2 or previous tax return
  • Copy of DWS Benefit Letter (Medicaid, FEP (cash assistance), and Food Stamps)
  • DWS Employer Verification Form (Form ESD 630) 
  • self-declaration-of-income/no-income (not the preferred method and to be used only after all other resources have been exhausted – may also slow down application).

Once the application is complete, please call 435-674-5757 and leave a message on the general assistance voicemail. You can also email your application to A staff person will follow-up and schedule an appointment. Please allow 2 business days for a response.

Please note: Due to staff constraints, we absolutely cannot serve walk-in appointments (with exception to court ordered community service clients coming in during designated hours).