Apply here for assistance

First name

Last name

Email

Phone

Address

Amount Requested

Please provide a few sentences on why you are seeking need and how the CCAF can help. Feel free to upload any supporting documents you feel would be useful to our committee. (bills, Doctors notes, etc.)

File upload

In some scenarios we may discuss your request with specific 3rd parties (examples include Town Social Worker or School Adjustment Counselor) to the extent we believe necessary to delivery services or an award. By checking this box you give your permission for your application to be discussed with a 3rd party (in confidence).