Consumer Assistance Program Application

Fairfield County Office: 418 South Broad Street, Lancaster, Ohio 43130 — 740-689-1494
Hocking County Office: 96 West Hunter Street, Logan, Ohio 43138 — 740-689-1494

Through our consumer assistance program, SOCIL is considering requests to secure technology devices or software, PPE, or transportation assistance. Applications are approved based on need and available resources. Applicants must submit all requested documentation — incomplete applications will not be considered.

“Per the Americans with Disabilities Act, qualified individuals must have a disability, or be the caregiver of a person with a disability, which impacts a major life area. The condition must be permanent. If the condition is in remission it must impact a major life area when active. Those with a history of drug use must be in recovery to qualify, and that history must currently impact a major life area.”

Who can apply

Individuals with disabilities, or guardians of people with disabilities.

Required documents

  • Proof of identity
  • Proof of current address
  • Proof of disability
  • Quote for the cost of the device or software
  • Explanation of how this assistance will help you or the recipient remain or become independent

Accepted proof of disability

  • Statement or letter from a physician, medical or mental health professional (on their letterhead)
  • Statement, record, or letter from a federal government agency that issues or provides disability benefits
  • Statement, record, or letter from a State Vocational Rehabilitation Agency counselor
Applicant Information
Disability Information
I am a person with a disability:
I am the legal guardian of a person with a disability:
Does the disability affect one or more of your activities of daily living?
Service(s) Being Requested
PPE (Personal Protective Equipment)
Transportation Assistance
Adaptive Technology Assistance
Disclaimer & Signature

I certify that the above information is true and complete to the best of my knowledge. If this application is accepted by Southeastern Ohio Center for Independent Living and it is found that false or misleading information has been provided, my application will be denied.

I understand that if I receive cash assistance it may not be used for the purchase of alcohol or tobacco products.

After completing the form, print or save it and return it to SOCIL by mail, in person, or by calling 740-689-1494.

Office Use Only
Required documentation received:
Approved: