MDC Service Intake Form

Please fill out the form to access MDC services. It may take about 10-15 minutes to complete.

For any questions or assistance, please contact (253) 284-9096 or

Please select your language.
Getting Started:
By filling out this form, you give permission to MDC to use your personal information for referrals to other internal programs and your anonymized information to our federal funding sources.  MDC will not share your personal information to any other entities. 

You must have access to this email address to confirm your application. 
Participant Info

You can use the calendar or type using MM/DD/YYYY.

Please use the placeholder address' format.

If unsure, please check "No."
Household Info

Household size includes you, your spouse, and any children, dependents, or relatives that lived with you last year.*

This includes unemployment, SSA, etc.

Service Need Info

Through a library, phone plan, or home access.

Optional Survey

Select all that apply

Thank you for taking the time to fill out this form.  Please click "Submit my Intake Form" to complete your submission.