Donate

Client Acknowledgement of Receipt

  1. Corporation Notice of Privacy Practices
  2. Client Rights and Responsibilities
  3. Client Complaint & Appeal Procedure
  4. Emergency Contact Form
  5. Agency Agency Snapshot/Benefits within the Organization
  6. Advance Life Planning
I,  
Name(Required)
hereby acknowledge that I received a copy of the Northwest Indiana Community Action,

A. Corporation Notice of Privacy Practices
B. Client Rights and Responsibilities.
C. Client Complaint & Appeal Procedure
D. Emergency Contact Form
E. Agency Snapshot/Benefits within the Organization
F. Advance Life Planning

MM slash DD slash YYYY

Recent News

All News

Central Office

Envisioning the people of Northwest Indiana flourishing regardless of income, ability, or age.

© 2021 Northwest Indiana Community Action Agency:  Sitemap | Privacy Policy | Intranet
Our services are provided without regard to race, age, color, religion, sex, sexual orientation, gender identity and/or expression, disability, national origin, ancestry, or status as a veteran.

Website by Addis Enterprises.