Kansas program application form 2025

1. Click ‘Get Form’ to open the Kansas Program Application Form in our editor.
2. Begin by entering your printed name in the designated fields for Last Name, First Name, and Middle Initial.
3. Input your Kansas Driver’s License Number or equivalent and Date of Birth in the specified format (MM/DD/YYYY).
4. If applicable, complete the section regarding dependents by providing the full name and SSN of the person who can claim you.
5. In the eligibility information section, check the appropriate box for public assistance received and initial next to it.
6. Indicate if your family income is below 100% of the Federal Poverty level by initialing in the corresponding field.
7. Finally, certify your application by signing and printing your name at the bottom of the form along with your driver’s license number.

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