Disclaimer:

The information provided on this form is confidential and will be used solely for the purpose of assessing eligibility for Comprehensive Community Support Services (CCSS). By completing and submitting this form, you consent to the collection, storage, and use of your personal information in accordance with applicable privacy laws and regulations.

Please note that submitting this form does not guarantee acceptance into the CCSS program. All information will be reviewed, and eligibility will be determined based on program criteria.

Your participation in CCSS is voluntary, and you may withdraw your consent to participate at any time by notifying our office in writing. If you have any questions or concerns regarding this form or the CCSS program, please contact us before submitting your information.

By submitting this form, you acknowledge that you have read, understood, and agree to the terms outlined in this disclaimer.