NCCARES Request Form

NCCARES Request Form

First Name*

Last Name*

Email Address*

Phone Number*

Phone

What is the best way to contact you?*

Select

Current State Employee*

Are you a current permanent State of NC employee?

Select

Eligibility

Thank you for your interest in the CARES program. At this time, you are not eligible. Please visit [website name} for additional resources.

Eligible for CARES Program

Please submit your request for benefits provided through the CARES program. We will be contacting you within 5 business days. You will be required to provide documentation of your diagnosis. Thank you.

Send me a copy of my responses

Powered by

Privacy Notice|Report Abuse