How Do I Apply?

How Do I Apply?

Individuals who meet the criteria may apply by completing and submitting the Program Application form and Release of Information to the Part C Program. Income verification is required for this program.

Acceptable means of income verification are:

  • W-2 Form
  • 1040 Form
  • 1040A Form
  • Paycheck Stubs
  • Medicare/Disability Payment Stubs

It is the responsibility of the applicant to provide information pertinent to the Title III EIS Program. All information is confidential. It is also the responsibility of the applicant to notify the program manager of any changes in address, phone number, and income status.