Register as a Trusted Community Based Organization

Please complete this 2-minute form so we can set up your account to help others apply. We will use your work-issued email to identify you as a caseworker. You will receive an email notification when your account is ready. You will use the same work-issued email to create your account.

Account Status: You must be logged into an account to complete this application *

Please enter your first and last name *

Community Based Organization name *

Tell us about your Community Based Organization *

How many caseworkers work for your Community Based Organization? *

Please enter your 10 digit phone number. *

By checking this box, I attest that I am a representative of a qualified Non Profit 501(c)(3) organization that provides benefit consulting to low income individuals. *

Email address *