Assistance Application

NON MEDICAL ASSISTANCE
USE THIS FORM ONLY FOR ASSISTANCE WITH:

Rent
Utilities
Electric Bills
Heating Bills
Water Bills
Indigent Deceased

The application for ALL non-medical requests may be obtained by clicking here.

You CANNOT SUBMIT YOUR APPLICATION ON-LINE! You must print the completed application, sign it and file it with the Kootenai County Assistance Office located at 451 Government Way, Coeur d'Alene, ID 83814. If you fill out the application in your own handwriting, please use black or blue ink.

MEDICAL ASSISTANCE
USE THIS FORM ONLY FOR ASSISTANCE WITH:

Medical Bills
Medication Costs

Please note that the medical application does require a lot of information. This is required by state law as all applications received by Indigent Services are shared with the Department of Health and Welfare to determine if the applicant is eligible for Medicaid payment of the medical services. Thank you for your patience and please be sure to complete the entire application.

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Please click here for Medical Assistance Application.