State regulations require that persons receiving assistance work or participate in activities to prepare them for work unless they are physically or mentally incapable of working. Any information you provide is confidential by Maine State Statutes.
The person named below has applied for General Assistance from the City of Westbrook.
(Insert Name as Agreement)
This client of the GENERAL ASSISTANCE PROGRAM has stated they are presently disabled.
In order to determine the eligibility of the above-named client to receive the assistance he/she is requesting, we require the following information:
(If unknown at this time, give date of next evaluation)
(If so, please specify)
(Select this box if you agree to the above statement)
This field is not part of the form submission.
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