Enrollment Application

If families are receiving any of this income, complete the following forms;

(Must have Social Security number on ADC/TANF forms)

SNAP  — Photocopy of the card or Eligibility Letter.

SSI — We will no longer collect SSI income. 

• Ask the type of SSI received.

• If they receive supplemental SSI, we will need proof. Families can use this link to request a letter as proof.  

ADC/TANF— DHHS release of information form AND an Income verification request form.

Income Verification form—This form is to be used when the parent/s:

• Don’t have W2’s or income tax or pay stubs

• Income has significantly changed

• Is receiving ADC/TANF ( also complete the DHHS Release of Information form)

Homeless/Kinship—Homeless/Kinship form, use this form if a family is living with another family due to loss of job, eviction etc. or living in a hotel, park etc. or if grandchild/ren are living with grandparents, aunt/uncle or other relative.

Self-Declared—Self Declared form is used if a Primary or Secondary adult has not worked in the last 12 months.

Self-Written— Self Written from is used if a Primary or Secondary adult has no documentation of income in the last 12 months.

Fillable Enrollment Application!