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How to use or fill out PLEASE NOTE: MUST BE 18 YEARS OR OLDER TO APPLY
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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Head of Household/Applicant Information section. Enter your first name, middle initial, last name, and Social Security number. Make sure to include your date of birth and select your sex.
Indicate if you are disabled and select your race/ethnicity from the provided options. This information is collected for statistical purposes only.
Complete the Household Information section with your legal address and mailing address if different. Ensure all details are accurate for effective communication.
List all household members, starting with adults followed by children under 18. Fill in their names, Social Security numbers, dates of birth, sex, disability status, and race/ethnicity as required.
In the Family Income and Assets section, provide total gross income for each family member aged 18 or older. Include all sources of income and specify how often they are received.
Finally, review the Eligibility and Preferences section carefully before signing to certify that all information is true and complete.
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