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Appointment Request Form

  1. Washtenaw County, Michigan homepage

  2. Appointment Request Form

    Please complete all required fields. Appointment requests will be responded to within 2 business days (Monday-Thursday).

  3. Benefit Type Requesting*

    Please select the benefit(s) you are requesting an appointment for.

  4. Are you a Washtenaw County Resident?*

  5. Please indicate two times you are available for an appointment. We typically schedule appointments in the afternoons starting at 1:00pm Monday through Thursday, closed on Fridays. We will try our best to accommodate your request to the best of our abilities. Not all time requests are guaranteed.

  6. Leave This Blank:

  7. This field is not part of the form submission.