Application for Assistance
Please complete the following application to be considered for assistance. Our resources have a variety of income qualifications, so it is difficult to tell you if you qualify until we have all of your information. Due to the volume of requests we get, please be patient. We will process your request in the order it is received.
If you would like to move forward and apply
please complete the application
Thank you for reaching out to Converse County CSBG.
Please complete our application for funds by clicking on the links below.
I have included an application link, a test link, and an upload link for documents to make servicing you easier during these times.
You will need to complete all 3 steps by completing each of the links.
Step one Application: please click on the link below
https://hipaa.jotform.com/201126388344049
Step Two- Please click on the link below
https://hipaa.jotform.com/201105202944138
Step Three- Please take pictures of all adults ID over 18, last 30 days income for all household members over 18. Copies of the bill you are requesting assistance with. please use this to upload requested documents from the application and throughout the process as it is HIPPA compliant