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Can we get your contact info?

*Your first name / given name
*Your last name / family name
Your suffix
*Your date of birth
*Mailing address line 1

This address will be used to mail notices and benefit cards.

Mailing address line 2
*City
*Zip code
*Would you like to give your cell phone number to get updates on your application?

By signing up you will receive text updates for each child on this application. If you do not provide a cell phone number, you will be unable to manage and track your application online.

*Cell phone number

Only enter numbers.

* Email
* What is your preferred written language for mailed notices?

*Would you like to go paperless and get your notices through email?

*Email for notices
You may choose someone to be an authorized representative. An authorized representative is a person that can submit an application on your behalf and can act on behalf of all school-going children in this application that are approved for Summer EBT benefits.
*Do you want to give permission to someone else to apply or get benefits for you?

*Required