Print an Application for Elderly and Persons

with Disabilities

The application is listed below and is available in PDF format in different languages.

Please choose your language.

English - Spanish (español)

Additional Information

After filling out your application, you need to send it to your local DCF office.  To find the address, phone number, and fax number for your local DCF office visit:  DCF Office Locator Map for a list of access sites.