Information Request Form Contact us for assistance by completing the form below. Name* First Last How would you like us to get in touch with you? Enter your primary contact information. EMAIL PHONE NUMBERWhat three main services do you need information about? Benefits - Medi-Cal, Food stamps (Cal-Fresh), General Assistance (GA), SSI or SSDI. Dental care - General and dentures DMV Identification card Shelter Information Coordinated Entry Food Resources Clothing Personal hygiene items Prescription and reading glasses Reading glasses Other (limit 10 words) Please, elaborate in the comment section below.Other CommentsReminder: Please remember to enter your contact information so a Service Coordinator can get in touch with you.Check our calendar for most up-to-date information Δ
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