Request for PCM Services At CLW, we want to make it as easy as possible for you to learn more about us and access our services from home Completing an online application ensures that we have all of the pertinent information in order to determine eligibility for the Personal Care Attendant Program. As part of this application, CLW will need to collect some personal and/or sensitive information to apply for the Personal Care Attendant Program. The information collected from is kept strictly confidential, which includes: Citizenship information Dates of birth Email addresses Home addresses Medical documentation Permanent resident number (referred to as alien registration number in this form for legal purposes) Phone numbers Social security numbers Please note, that you will need to complete this application in its entirety because you are unable to save and continue. You will need to complete the application in one sitting.

Thank you for submitting your application online. We will contact you as soon as we are able. If you have any questions, please feel free to contact our main office at 508-798-0350. Thank you for choosing our services!