How to sign up Online:
Five County Community Action uses an information Kiosk for the first part of its application.
Please review these instructions prior to applying. You may also download instructions as a PDF file here: Kiosk – Client – Submitting Application online
Step 1: Create account by clicking New User button and proceeding to enter email and password.
Step 2: Enter Household Information
Progress can be monitored by referencing progress bar at the top of the page. All fields displaying red text are required to save the page.
At the bottom of the page, click the applicable button to save and come back, save and continue the application process, or skip the current page (can be completed at a later time).
Step 3: Enter Household Member
When prompted, select ‘Yes’ if household member being entered will be the person applying to the program and ‘No’ if not.
Step 4: Proceed to edit or remove existing household member, add additional household members or proceed to enter income by clicking Next.
Complete household information and personal information for all members of the household.
Step 5: Enter Income (additional sources can be added after saving initial income)
Income should be provided for all household members 18 and older. For income such as child support, this must be listed because it is the parent or guardian receiving the income on behalf of the child.
Step 6: Apply for Programs by clicking the link to the right of the applicable household member.
IMPORTANT: Programs such as food pantry, housing, utility assistance, etc. cover the entire household. For these programs, please only have the primary applicant apply.
Step 7: Submit requested documents based on applied programs by clicking blue upload link/button.
Under Required Documents, click “Upload Required Documents.”
NOTE: The required documents needed will changes based on the programs that are selected.
Here are the required documents that must be uploaded:
- Income verification for all members over 18
- Last 30 days of earned income (NOTE: 3 months of income is required if applying for weatherization)
- Last 30 days of bank statement
- Benefit letters (SSDI / SSI)
- Child Support Letter
- W2(‘s) or previous tax return
- DWS Employer Verification Form (Form ESD 630)
- Self-Declaration of Income (for self-employment or no income (not the preferred method and to be used only after all other resources have been exhausted – may also slow down application).
- Release of information form
Step 8: Complete survey if prompted, otherwise, proceed to Affirmation & Consent page.
Step 9: Save and complete at a later time or submit application.
Your application will not be considered complete unless all information is completed and uploaded.
Please allow 3 business days for someone to follow-up with you as well. For any questions, please call Community Action at (435) 674-5757
Once you have read the above information, go to online application system to get started.