This application is for individuals living within Western North Dakota who are seeking assistance in acquiring diapers for their dependents. Please complete this application in full. Incomplete applications will not be considered. Application needs to be filled out only at first visit.

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(Diaper Assistance Eligibility: All applicants must provide proof of identity. (Ex: driver's license or other photo ID. Photo is required.) All applicants must live in served area. Applicants must be one or more: Income restricted​- If income is restricting you from getting diapers, and you qualify for any government assistance (Medicaid, SNAP, WIC, etc.), please submit proof of assistance- If income is restricting you from getting cloth, but you do not qualify for government assistance, please explain why. Furloughed- If you are affected by a government shutdown, Please upload your government ID or paperwork showing you are a government employee and are not getting paid due to the shut down. US Veteran or Active Duty in immediate Family- Show LES, DD214, or ID card. Fostering children- Show placement paperwork. Disaster victim- Must show proof from Red Cross. ​Refugee- Must show proof from USCIS