Paper Applications

Print Paper 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:

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 nreeves@fivecounty.utah.gov. A staff person will follow-up and schedule an appointment. Please allow 3 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).