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Note:Theapplicantmustalsoincludethemselvesinthissection 2026
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- Select the appropriate intake type at the top of the form by checking either 'New Client', 'Lost Card', or 'Update Info'.
- Fill in your Client Name, ensuring to include both first and last names.
- Indicate if you are homeless by checking 'Yes' or 'No'. If applicable, provide your street address, including apartment number.
- Complete the City, State, and ZIP code fields accurately.
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- Enter the number of individuals in your household.
- Sign and date the form at the bottom to certify that all information is correct.
- In the Household Members section, ensure you include yourself by filling out your name, birthdate, gender, and any relevant checkboxes for disability or veteran status.
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