Customer Intake Application Form – This form is required if you are applying for any of our program services. You can fill out the form online here or download and print it here.

WEATHERIZATION PROGRAM:

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

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

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

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: Lori Ozores at her email: lozores@uccac.com or call: 845-338-8750, ext. 112.

HEAD START & EARLY HEAD START PROGRAMS:

• Child Dental Form – EHS & HS
• Child Physical Form – HS & EHS
• HSEHS Request for Interview FILLABLE English Spanish
• Inkind – Property
• Group Inkind HS EHS Form
• INKIND Volunteer Form HS EHS