Client Forms


Our forms are provided to our clients in this section.  If you do not see what you are looking for, check in our programs section or  contact: Darlene Simms at her email or call: 845-338-8750, ext. 120.

Weatherization Application – Homeowners   UCCAC Customer Application Intake Form May 2018 fillable

Application and Forms are currently being updated. Please call for an application. We apologize for any inconvenience.

  1. Cover Sheet
  2. DHCR#4 –Weatherization Application
  3. DHCR#5A – Energy Information
  4. DHCR#3 – Personal Privacy Protection Form
  5. Weatherization Partnership Agreement
  6. Client Information Sheet – House
  7. Client Information Sheet – Mobile Home
  8. NYSERDA/Empower Application

* Renters along with Landlords need to call the office for information and applications.

* Group Homes and Shelters need to call the office for approval.

HEAD START & EARLY HEAD START PROGRAMS:      UCCAC Customer Application Intake Form May 2018 fillable

Program Year Calendar/Handbook: EHS&HS Parent Handbook & Calendar PY2017-18

Child Physical and Dental Form: Child Dental Form – EHS & HS Child Physical Form – HS & EHS

Head Start Application:  App – fillable EHS&HS English&Spanish