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LET'S COMPLETE THIS PROCESS

This is the final page for your intake process. Please complete steps 1-3 for all program and steps 1-4 for the EFSP program. You may have to visit this page several times to complete all steps. If additional documentation is required, your Care Navigator will notify you.

All required documentation is due within 48hrs of receiving your initial application for services. If we do not receive your documentation within 48hrs, we will mark your application incomplete. You will have to reapply for services. All programs operate on a first come first served basis.

STEP #1- IDENTIFICATION

Thank you for submitting your intake form

PLEASE SUBMIT A CURRENT COPY OF YOUR IDENTIFIATION: CURRENT DRIVER'S LICENSE, PASSPORT, STATE/TERRITORY ISSUED ID, GOVERNMENT ISSUED ID/SENIOR CARD, OTHER

STEP #2- INCOME VERIFICATION

PLEASE SUBMIT ONE THE FOLLOWING DOCUMENTS FOR PROOF OF INCOME:

1. (2) MOST RECENT CHECK STUBS

2. PRIOR YEAR 1040 FORM

3. IF UNEMPLOYED, WAGE INQUIRY STATEMENT FROM THE DEPARTMENT OF LABOR

4. SOCIAL SECURITY BENEFITS

5. GOVERNMENT ASSISTANCE (OTHER

6. OTHER INCOME VERIFICATION REQUESTED BY CAN CARE NAVIGATOR

STEP #3 - PROOF OF RESIDENCY

PLEASE SUBMIT ONE THE FOLLOWING DOCUMENTS FOR PROOF OF RESIDENCY:

1. CURRENT LEASE OR MORTAGE STATEMENT IN YOUR NAME

2. UTILITY BILL IN YOUR NAME (LIGHT, GAS OR WATER)

3. NOTARIZED STATEMENT FROM PROPERTY OWNER WITH COPY OF THEIR DEED OR MORTGAGE STATEMENT

5.OTHER AS REQUESTED BY CARE NAVIGATOR

*BASED ON PROGRAM REQUIREMENTS ADDITIONAL DOCUMENTATION MAY BE REQUIRED.

STEP #4 - if applicable

PLEASE SUBMIT ONE THE FOLLOWING FOR THE EMERGENCY FOOD & SHELTER PROGRAM (EFSP)

1. MOST RECENT DELINQUENT UTILTY BILL (GAS, LIGHT OR WATER)

2. MOST RECENT DELINQUENT MORTGAGE OR RENT STATEMENT

*BASED ON PROGRAM REQUIREMENTS ADDITIONAL DOCUMENTATION MAY BE REQUIRED.

STEP #4 - UTILITY, RENT OR MORTGAGE STATEMENT FOR EFSP Progr

PLEASE SUBMIT ONE THE FOLLOWING DOCUMENTS FOR EMERGENCY ASSISTANCE PROGRAM:

1. DELINQUENT RENT PAYMENT BILL

2. DELINQUENT METERED UTILITY BILL - WAPA (WATER OR POWER)

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