Skip to content
Search for:
FIND HELP
Eligibility & Registration
Client Services
FAQs
Community Resources
WAYS TO GIVE
Donate Online
Donate Goods
Volunteer
Shop to Donate
Host a Drive
Sponsorship
ABOUT US
Our Services
Our New Home
Staff & Board of Directors
Join Our Team
Videos
Our Partners
CONTACT
NEWS & EVENTS
DONATE
Search for:
FIND HELP
Eligibility & Registration
Client Services
FAQs
Community Resources
WAYS TO GIVE
Donate Online
Donate Goods
Volunteer
Shop to Donate
Host a Drive
Sponsorship
ABOUT US
Our Services
Our New Home
Staff & Board of Directors
Join Our Team
Videos
Our Partners
CONTACT
NEWS & EVENTS
DONATE
CLIENT REGISTRATION FORM
For new & existing clients
Client Registration Form
Jennifer Cain
2021-05-19T11:37:17-04:00
SASS Client Registration & Requalification Form
Please enable JavaScript in your browser to complete this form.
Choose one of the following options:
*
I am a new client filling out this form for the first time.
I am an existing client filling out this form to requalify for assistance.
Date
Name
*
First
Last
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
Email
*
Is there a veteran in the household?
Yes
No
Household Members
Please list all, including yourself.
Household Member 1
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 2
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 3
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 4
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 5
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 6
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 7
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 8
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 9
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Household Member 10
Name
First
Last
Date of Birth
Age
Sex
Male
Female
Please check all the boxes below to indicate that you will bring the following documents to the SASS office (224 W. Michigan Ave., Saline, MI) in order to complete your registration:
*
2021 Income Tax Return/proof of income (SSI, SSDI, child support, unemployment) for all members of the household
Proof of residency in the Saline School District, proof of School of Choice, or proof of employment in the City of Saline (accepted documentation includes lease, water bill, DTE bill, school of choice letter or most-recent student report card, or paystub from employer).
Driver’s license for all adults in the household.
All of the documents listed above are required to register as a SASS client. If you have questions, call (734) 429 - 4570.
SUBMIT
Page load link
Go to Top
