Assistance Request

If you are seeking assistance from ACCAC, please take a moment to fill out the form provided.

This helps us prepare for your appointment and ensures we can meet your needs as quickly and efficiently as possible.

Our Hours:

Monday, Tuesday, Thursday and Friday 11:30-3:00. Closed Saturday, Sunday and Wednesday

To complete your appointment, please bring the following items with you:

  • A current (non-expired) photo ID or driver’s license
  • Proof of income for all residents living in the home
  • Social Security cards for every household member

Having these documents ready allows us to verify eligibility and provide the correct assistance during your visit.

If you have any questions or need help completing the form, please let us know—we’re here to help.

Your Name(Required)
Current Address(Required)