MDC Service Intake Form

Please fill out the following application form.  The form should take about 10-15 minutes to complete.

Be sure to press submit at the end of your application, otherwise MDC will not receive your information. 

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. 

For any questions or assistance, please contact us by phone, at (253) 284-9096 , or by email, info@mdc-hope.org. Thank you so much for your time.