CiACC Online Application
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Register
We are no longer accepting registrations for this season.
Referring Agency
Account Information
(NOTE: If you are a
REFERRAL AGENCY
or
PROVIDE
toys and/or food to CIACC clients do
NOT register with this site. In that case please contact Ciacc for your log in information.
Registering is only for people looking to receive assistance.)
Step 1: Enter your referring agency's pin #
Your referring agency will verify your qualifications for assistance.
Referral Agency's Pin #
Is this your correct referring agency?
Step 2: Create a new account
Last Name
The Last Name field is required.
First Name
The First Name field is required.
Phone #
The Phone # field is required.
Email
The email field is required.
Password (minimum 4 characters)
The password field is required.
Confirm password
The confirm password field is required.
The password and confirmation password do not match.