Application Forms

Printable blank application forms for all our services

Blank Application Forms

The below forms may be dropped at a secure drop box, at one of our offices, during regular business hours, 8:30 a.m. to 5:00 p.m or submitted by fax to 510-670-5095 or by mail at P.O. Box 12941, Oakland, CA 94604.

Medi-Cal:

SAWS 2 Plus (04/15)EnglishSpanishChineseTagalogVietnameseFarsiKhmer

CalFresh Application:

CF 285 (6/19)EnglishEnglish (Large Print)SpanishChineseTagalogVietnameseFarsiKhmer

CalFresh Renewal:

CF 37 (11/16)EnglishSpanishChineseTagalogVietnameseFarsiKhmer

Medi-Cal Initial Application:

CCFRM604 (11/13): EnglishEnglish (Large Print)ArabicArmenianChineseFarsiHmongKhmer KoreanRussianSpanishSpanish (Large Print)TagalogVietnamese

General Assistance Application:

Form 90-16 (04/20): English

Accommodation Request Cash:

Form 90-152 (05/19)EnglishSpanishCambodianChineseFarsiVietnamese

Assistance Program for Immigrants (CAPI)

SOC 814 (12/20):  English

Additional Forms for CalWORKs, CalFresh and General Assistance:

SAR 7: EnglishSpanishChineseTagalogVietnameseFarsiKhmer

SAR 3: EnglishSpanishChineseTagalogVietnameseFarsiKhmer