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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.


Intake Application
Aplicación de Admisión

Rental Assistance

We are currently accepting applications for Erath, Hood, Johnson, Palo Pinto, Parker, Somervell, Wise Counties.

TBRA Application

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.


CNA Application

Payee Services Application

If you, or someone you know, needs a representative payee, we can help. Follow the link below to complete the application.


Payee Services 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.


Self Certification of Disability Form

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.


Housing Inspection Checklist

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.


Employment Application



If you know anyone interest in our Retired Senior Volunteer Program(RSVP), please have them fill this application out. Link to application below. 

                                        RSVP Application

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


Declaration of Income Form

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