Client Eligibility Form

Applying for services at ECCO begins by completing our Client Eligibility form. Once we’ve received ALL REQUIRED information and documents, an ECCO team member will follow up within 10 business days using the contact information you provide below. All individuals who are approved to receive services at ECCO must complete our client eligibility process annually to ensure you still qualify as a client.  

Please note we will not contact you to process your application until ALL required information and supplemental forms (links at bottom of page) for this application are submitted. If supporting documents are not turned in within 10 days of application, the application will be shredded and discarded. Thank you. 

Questions? Or unable to attach the required documents? Please call (843) 849-9220 to speak with an ECCO representative.

Become a Client Form

Personal Information

Name(Required)
Address(Required)
Drop files here or
Max. file size: 50 MB.
    (Examples include: Driver's License, Passport, Military ID, Tribal ID, EAC, etc.)
    Please enter a number from 1 to 99.
    Please enter a number from 0 to 99.
    Drop files here or
    Max. file size: 50 MB.
      If the bills aren't in your name, you will need to complete ECCO's Documentation of Physical Address form (see form at bottom of page):
      Regardless of status, all applicants must complete ECCO's Declaration of Insurance form (see form at the bottom of page)
      What services are you interested in receiving?(Required)
      Select all that may apply.

      Employment

      What is your current source of income?(Required)
      Select all that may apply.
      (if applicable)
      (if applicable)
      Please enter a number from 0 to 1000000.
      Drop files here or
      Max. file size: 50 MB.
        Proof of Income Graphic

        Other Info

        How did you hear about ECCO?(Required)
        Select all that may apply.
        Release of Information Agreement(Required)
        Client Services Agreement(Required)

        ECCO’s Supplemental Forms for Client Eligibility:

        (Click on each form below to open and download)