P.O. Box 352 Pleasanton, TX 78064
If you experience difficulties submitting the application through your phone, please try again using a personal computer or by visiting your local library as they are familiar with our website. Thank you for your understanding.

Request Assistance

This application is for screening purposes only and does not guarantee your eligibility to receive services. This application will be provided to the AIC committee for review and a decision will then be made as to the merit of the request.
Please complete all questions truthfully.

Personal Information

Please provide your full name.
Please provide your drivers licsense number.
Please provide your social secruity number.
Please provide a valid email.
Please provide a valid home or mobile number.
Please provide a valid home street address.
Please provide a valid city.

Household Information

Assistance/Income Information


Employment/Education Information

Additional Information


Upload Documentation

Required documentation:

  • Copy of an ID for of all family members in household.
  • Copy of the bill you need help with or the lease if it is rent.
  • Copy of your income for the last month. (Check stub, letter or estimate if no check stubs or unable to acquire a letter.)
  • Proof of income from everyone in the household. (This includes wages, family help, SSI, Medicare, etc.)

Application will not be considered if any requested documentation is not provided.

Hold Ctrl and select multiple files

The statements above are true and the assistance that you are requesting represents your situation truthfully.

I understand that this application and information will be presented to the committee and I, ______________ authorize and give permission for the release of this information to the Atascosa Inter-Agency Council (AIC) and any other agency for verification of the statements and for determination purposes.

I further understand I am subject to prosecution for providing false or fraudulent information and can be denied additional assistance.

Atascosa Inter-Agency Council Inc.
Formed in May 1999. A 501(c)3 non-profit organization.
50+ agencies networking together for the residents of Atascosa County.