Print Paper Application:
To access direct Five County services, click 2019 Community Action Application- 3Jun19 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(‘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).
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 email@example.com. 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).