Paper Applications

Print Paper Application:

To access direct Five County services, click 2018 Community Action Application- 14Feb18 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:

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 capuser@fivecounty.utah.gov. 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).