Note:Theapplicantmustalsoincludethemselvesinthissection 2025

1. Click ‘Get Form’ to open it in the editor.
2. Select the appropriate intake type at the top of the form by checking either 'New Client', 'Lost Card', or 'Update Info'.
3. Fill in your Client Name, indicating your first and last name. Ensure accuracy as this is mandatory for receiving assistance.
4. Indicate if you are homeless by checking 'Yes' or 'No'. If applicable, provide your street address, including apartment number.
5. Complete the City, State, and ZIP code fields accurately.
6. Specify your preferred language and ethnicity in the designated fields.
7. Enter the number of individuals in your household.
8. Sign and date the form at the bottom to certify that all information provided is correct and complete.
9. In the Household Members section, ensure you include yourself along with other members by filling out their names, birthdates, gender, and any relevant checkboxes for disability or veteran status.

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