If you need assistance with filling out this form, please call our office at (228)-604-4020.
If you would prefer to print and mail the form, you can download it HERE
Total household Income
Qualifications for assistance will be reviewed and if you meet guidelines, our office will contact you for additional information.
You can apply online at www.disabilityconnection.org or mail the application to:
Address: 700 Pass Road, Gulfport, MS 39501