Community Assistance - Applications for Assistance

Request an Application for Public Assistance
There are three options for obtaining an application.

Online - Print the application (pdf). Acrobat Reader is required to view and print this application. If you do not have Acrobat Reader on your computer, please visit the Adobe Web site to download the free software.
Telephone - To request an application, call 303-271-4006.
In person - Pick up an application at the Human Services Building located at:
900 Jefferson County Parkway, Suite 130, Golden, Co 80401-6010.

To get started, you must fill out an application.

Download the online application:

You may also pick-up an application in person, request one over the telephone, by mail, or have someone pick one up for you.

All sections must be complete. An application can be mailed to or dropped off at our location:

    900 Jefferson County Parkway
    Room 110
    Golden, Colorado 80401

In addition, the application can be faxed to 303-271-4040.

Once we receive your application, your application will be screened, and you will be scheduled for an interview with a member of the Intake team to determine your eligibility.

Can I Get Food Assistance?
To see if you qualify for food assistance, a pre-screening tool is available on line.
Check the Supplemental Nutrition Assistance Program.

This pre-Screening tool is not an application for Food Assistance, nor does it guarantee eligibility. To get started, our office must receive a completed application.

Check Eligibility / Status
You may check to see whether you are eligible for benefits such as food assistance, cash assistance, or family/children's medical assistance programs, or check the status of your current benefits with the State of Colorado's new Program Eligibility and Application Kit (PEAK).

For security reasons, you must establish a user profile and must know your Case ID number. In addition, applicants who have applied for benefits, but have not been initially notified of the status of their eligibility determination, will not be able to use this tool to determine the status of their application at this time.

We are located in the Human Services building at:
900 Jefferson County Parkway
Golden, Colorado 80401
Phone: 303.271.4006
Fax: 303.271.4040

Download the online application

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Last Modified: Feb 2, 2010 02:30 PM