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Complete the following application to be considered for services from All Community Outreach.

Only one application per household is permitted. Failure to comply will result in suspension of services.

If other than English, select language.

Please make sure to enter the head of household first.

Head of Household

Please enter your name as it appears on your driver's license or other ID.

First Name

Middle Name

Last Name

Birthdate (MM/DD/YYYY)

Gender

Race

Ethnicity

Individual Gross Monthly Income

Please do not include $, commas or decimals

Employer's Name

Please leave blank if you are unemployed

Are there any more people in your household? Including children and adults?

YesNo

Complete for each member of your household, including children and adults.

SEE "ADD ANOTHER HOUSEHOLD MEMBER" UNDER EMPLOYER'S BOX BELOW

Additional Household Members

First Name

Middle Name

Last Name

Birthdate (Month/Day/Year)

Gender

Race

Ethnicity

Individual Gross Monthly Income

Please do not include $, commas or decimals

Employer's Name

Please leave blank if you are unemployed

I have entered all members of my household, including children and adults. I understand that ACO will verify this information. Fraudulent information will prevent any assistance in the future.

Yes

Affidavit

AGREEMENT

I certify this application has been complete to the best of my knowledge with complete & accurate information. I understand that false statements or omissions of facts relevant to my eligibility for assistance will be considered fraud and that I may be prosecuted under applicable U.S. Codes for this fraud. Furthermore, I understand that assistance granted to my household based on fraudulent information must be reimbursed in whole.

Important; Section 101 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentation to any department or agency of the United States Government as to any matter within its jurisdiction.

I am signing this Application and Affidavit by electronically entering my name below.

Date

First Name

Last Name

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IMPORTANT: All documents are REQUIRED to be considered for Cares Center assistance. If you do not have a document, please provide an explanation.

Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.

Copy of a photo identification for all household members 18 years or older (Driver’s license, passport, permanent resident cards, etc.)

Do you pay a utility bill?

YesNo

Copy of your most recent (NOT a disconnect notice) Utility bill. Utility bill must be in the name of the applicant

See example bills here: acocares.org/example-bills. You can find your bill online, if you have troubles finding it, contact your utility provider

Explanation For No Utility bill

Example: Utility is included in my rental agreement.

Do you have any children in your household under the age of 18?

YesNo

Copy of student enrollment forms for each child ages 5 years to 18 years, and a copy of birth certificate for each child younger than 5 years of age.

You can reach out to the child's school administrator for the enrollment forms or contact the county office for a copy of the birth certificate

Explanation For No School Enrollment

It we require additional documentation, we will send you an email from noreply@acocares.org

Please check your spam/junk folder, as it may end up there. You will have 2 business days to resubmit your documentation, otherwise your account will be suspended for 30 days.

Affidavit

I acknowledge that the documents submitted are correct and accurate. If they are found to be incorrect, I understand that this will delay the Intake process and possibly place my application on a 30-day suspension, where I will be unable to request assistance until after the 30 days.

First Name

Last Name

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IMPORTANT: All documents are REQUIRED to be considered for assistance. If you do not have a document, please provide an explanation.

Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.

Copy of a photo identification for all household members 18 years or older (Driver’s license, passport, permanent resident cards, etc.)

Copy of your most recent (NOT a disconnect notice) electric bill. Electric bill must be in the name of the applicant

See example bills here: acocares.org/example-bills. You can find your bill online, if you have troubles finding it, contact your electric provider

Do you own a home?

YesNo

Copy of your most recent mortgage statement or deed if your home is paid off

Explanation For No Mortgage

Example: I rent an apartment.

Do you rent a house or an apartment?

YesNo

Copy of your rental agreement or lease COMPLETED AND SIGNED by you and your landlord (At least first 2 pages and last page).

You can request a PDF file of your full signed lease from your leasing office or landlord

Explanation For No Lease

Example: I own my home.

Do any members of your household over the age of 18, including yourself, have a bank account? (Including Chase, Prosperity, Wells Fargo, Bank of America, Truist, Chime, Cash App, Venmo, etc.)

YesNo

Copy of bank statements (checking and savings) for each household member 18 years or older for the past 30 days

You can find a PDF file of your recent bank statement online. If you have trouble finding it, contact your bank

Explanation For No Bank Statement

Example: There is no bank account in my household.

Do you have a current resume?

YesNo

Copy of your current resume

Please be aware that once all the correct documents have been submitted, you will be sent an email with a link to set up a meeting with a Case Director. At the time of the meeting, the Case Manager will determine the type and amount of financial assistance we will be able to assist with, if found eligible.

It is important to note, that financial assistance is not always guaranteed, however, you may be offered other types of non-financial assistance or resources instead.

Affidavit

I acknowledge that the documents submitted are correct and accurate. If they are found to be incorrect, I understand that this will delay the Intake process and possibly place my application on a 30-day suspension, where I will be unable to request assistance until after the 30 days.

First Name

Last Name

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Please ensure that all files are clear and legible before uploading.

Copy of a photo identification for applicant(s) receiving services (Driver’s license, passport, permanent resident cards, etc.)

Do you have a current resume?

YesNo

Copy of your current resume

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Only one application per household is permitted. Failure to comply will result in suspension of services.

Please make sure to enter the head of household first.

Complete for each member of your household, including children and adults.

SEE "ADD ANOTHER HOUSEHOLD MEMBER" UNDER EMPLOYER'S BOX BELOW

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IMPORTANT: All documents are REQUIRED to be considered for assistance. If you do not have a document, please provide an explanation.

Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.

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IMPORTANT: All documents are REQUIRED to be considered for Cares Center assistance. If you do not have a document, please provide an explanation.

Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.

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IMPORTANT: All documents are REQUIRED to be considered for assistance. If you do not have a document, please provide an explanation.

Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.

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Please ensure that all files are clear and legible before uploading.