Welcome

This assessment form allows you to obtain information regarding programs that may be of assistance to someone that you care for, a loved one, or yourself. This is a resource service and does not guarantee eligibility. In order to determine true eligibility, please use the "Contact" button on the following page.

The information you provide is only used to help you research available assistance and information. It is not stored or saved for other purposes.

Note: If you are filling this out for someone else, please be sure to fill in THEIR information on the following questions.

(Interactive form to come.)

Helpful Numbers

Child Abuse Hotline

(209) 468-1333

Elder Abuse

(209) 468-3780 or
(888) 800-4800

Fraud Hotline

(209) 953-7733