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ONLINE APPLICATION
FOR SERVICES


 

PERSONAL HYGIENE/DIAPER PANTRY, TOOL LOAN PROGRAM, REFERRAL TO PARTNER AGENCIES, VOLUNTEER WITH US

Simply complete this form here and we will get back to you within 48 hours of submission. Thanks!

The Compassionate Connections Center offers programs and assistance services to individuals residing within the Clintonville School District or to qualifying individuals by referral. Services offered by the Compassionate Connections Center are subject to change at any time. Please allow 48 hours for application processing.

  PERSONAL INFORMATION                                                                                                            

  HOUSING DETAILS                                                                                                                                

Additional Household Members (If Applicable)

  PROGRAMS AND SERVICES OF INTEREST                                                                      

Products are provided on a FIRST COME, FIRST SERVED basis and I relinquish The Compassionate Connections Center of all liability of any nature whatsoever and accept these products “AS IS” and at my own risk. You will not sell the products.

Rent tools from our tool lending program to use for things such as home repair, projects, etc.

Mental Health Navigation, Health Insurance Support, Food Pantry, Head Start, Translating/Interpreting services, etc.

I/We are interested in following services:

Volunteer with us! When volunteering with us you agree to protect the confidentiality of our clients.

Note to Applicants: If any information on this application is found to be false or incomplete, such finding may be grounds for denial of requested assistance and may be a basis for debarment from participation in all Compassionate Connections Center Inc Programs.

Inappropriate behavior such as profanity, verbal abuse of staff or any other disruptive behavior is prohibited. Any such behavior may result in the suspension or termination of your privileges at The Compassion Connections Center.

Thank you! We'll be in touch within 48 hours of submission.

The Compassionate Connections Center Inc. is proud to be an Equal Employment Opportunity and Affirmative Action Organization. We celebrate diversity and do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability status, or any other applicable characteristics protected by law.

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