How to Apply

For Assistance

If you need assistance with the application process please contact Todd Rickert at trickert@countysocialservices.org or (319) 824-6779.

How to Apply

Please find below our Region Application along with our Notice of Privacy Practices. All residents of counties in the County Social Services region are eligible for Information & Referral and Crisis Services regardless of eligibility criteria.  You may also complete an application online at https://www.iacsn.org/apply

Please see below for a brief summary of our criteria:

General Eligibility:

• The individual is a child under 18 years of age if applying for Children's Behavioral Health services, or the individual is at least 18 years of age if applying for adult mental health/disability services.  An individual who is seventeen years of age and is receiving publicly funded children's services may be considered eligible for adult services through the regional service system during the three-month period preceding the individual's eighteenth birthday in order to provide a smooth transition from children's to adult's services.  
• The individual is a resident of this state if an adult, and if a child, the custodial parent is a resident of the state of Iowa, and the child is physically present in the state.

Diagnostic Eligibility:

• Children - A child must be diagnosed with a serious emotional disturbance (IC 225C.2).
• Adults - The individual must have a diagnosis of Mental Illness, Intellectual Disability, Developmental Disability, or Brain Injury.

Financial Eligibility:

• Children - The child's family has countable household income equal to or less than 500% of the federal poverty level.  Countable household income and family size shall be determined using the modified adjusted gross income methodology.  An eligible child whose family's countable household income is at least 150% and not more tha 500% of the federal poverty level shall be subject to a cost share as described in IAC 25.16(3).
• Adults - Gross incomes 150% or below of the current Federal Poverty Guidelines.  Outpatient mental health services may be funded on a sliding fee scale basis.  Individual has resources below $2000 or under $3000 for a multi-person household.

Turning in Your Application

• You may email application materials to trickert@countysocialservices.org
• You may fax application materials to (833) 520-4869
• You may mail application materials to our central office at
  • 706 H Avenue, Suite 1
    Grundy Center, Iowa 50638

Application Materials

• Pre-Screen Online Form
• PDF Application
• Key Documents

Crisis Services

If an emergency is life threatening, call 911 or go to the nearest hospital emergency room.

Crisis mental health services are available at our designated mental health centers and hospital emergency rooms. The Clerk of Court located in your county is the access point for involuntary commitments. Application for financial assistance must be made to your County Social Services office after stabilization.

Pre-Screen Application Form

Fill out our online pre-screen form to learn if you're eligible for our services for children and adults. 

Apply Now