ACCIS Service Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in receiving services from the Arab Community Center for Integration Services (ACCIS). Please complete this Request form and select the service you are requesting. If you have any questions, you may reach us at 916-672-1183 or info@ACCIS-Sac.org.

Email *

Name *

Address

Phone Number *

Referral/Assistance Service Requested: (Please submit a new form for each service requested) *

Assistance with School Enrollment

Parent/Teacher Support

Assistance with Phone/Written Communications with the Department of Human Assistance/Social Security Administration

Completing eligibility forms to qualify for services

Translation & Interpretation

Interpreting Medical Appointments

Assistance with studying for the DMV Written Test

Referral for Driving Lessons (temporarily on hold)

Referral to ESL classes

Referral for Change of Immigration Status

Assistance with licensing for a home food business

Assistance with starting a home-based business

Job Referral

Assistance with Applying for a State Job

Other

Required

If you selected other above, please explain

How did you hear about us? *

Facebook

Instagram

ACCIS website

Newsletterا

Word of mouth

Google search

Other

Required

Referred by

Service Agreement: Please check the applicable box below to indicate your agreement: *

As a return to the service I received, I agree to volunteer at ACCIS the number of hours identified by staff.

My client agrees to volunteer at ACCIS the number of hours identified by staff as a return for the service they received.

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms