Applications and Forms
Please see the applications for assistance below, along with additional forms that may be required to be completed. Applications can be completed online, mailed, emailed, or faxed in.
Mailing Address:
114 Needham Street
Coleman, TX 76834
Email Address:
Fax Number:
(325) 625-3335
Intake Application
(for online submission)
Intake Application
(to be printed)
Currently Unavailable. Sorry for the inconvenience.
Please follow the link below to apply for assistance. Print the application and send it in along with the required support documents. Applications may be sent via mail, email, or fax.
Rental Assistance
We are currently accepting applications for Erath, Hood, Johnson, Palo Pinto, Parker, Somervell, Wise Counties.
CNA Application
Please follow the link below to find the application for CNA classes. Print out the application, and send it in to us along with the support documentation, so we can determine your eligibility.
Payee Services Application
If you, or someone you know, needs a representative payee, we can help. Follow the link below to complete the application.
Self Certification of Disability
If you, or someone in your household is disabled, but does not receive SSI or Social Security Disability, follow the link below and complete the form. Attach to your application once completed.
Housing Inspection Form
Please follow the link below to download the housing inspection form. You can use the form as a checklist for you or your landlord to make sure your future rental property will be up to standards.
Employment Application
Please follow the link below to find our employment application. We do not accept applications unless there is an open position, so check the employment page prior to completion.
RSVP
Application
If you know anyone interest in our Retired Senior Volunteer Program(RSVP), please have them fill this application out. Link to application below.
Declaration of Income
If you, or someone in your household over 18 years of age does not have any income, follow the link below and complete the form. The form must be signed, then attached to your application